Healthcare Provider Details

I. General information

NPI: 1275837882
Provider Name (Legal Business Name): SN RADIOLOGICAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

1 HEALTHY WAY ATTN: PHYSICAN BILLING
OCEANSIDE NY
11572-1551
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-4656
  • Fax:
Mailing address:
  • Phone: 516-255-1616
  • Fax: 516-255-4672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN LASTIG
Title or Position: PRESIDENT
Credential: MD
Phone: 516-632-4656