Healthcare Provider Details

I. General information

NPI: 1376308205
Provider Name (Legal Business Name): SHORE POINT MEDICAL IMAGING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 E MAIN ST STE A
PATCHOGUE NY
11772-3105
US

IV. Provider business mailing address

239 E MAIN ST STE A
PATCHOGUE NY
11772-3105
US

V. Phone/Fax

Practice location:
  • Phone: 631-730-7534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RONALD LANDAU
Title or Position: OWNER
Credential: MD
Phone: 631-730-7534