Healthcare Provider Details

I. General information

NPI: 1174586879
Provider Name (Legal Business Name): RICHMOND HILL RADIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11614 MYRTLE AVE
RICHMOND HILL NY
11418-1748
US

IV. Provider business mailing address

11614 MYRTLE AVE
RICHMOND HILL NY
11418-1748
US

V. Phone/Fax

Practice location:
  • Phone: 718-846-0606
  • Fax: 718-846-8684
Mailing address:
  • Phone: 718-846-0606
  • Fax: 718-846-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number196198-1
License Number StateNY

VIII. Authorized Official

Name: WEN YI WANG
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-846-0606