Healthcare Provider Details

I. General information

NPI: 1134519630
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING OF ROCKVILLE CENTRE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE SUITE 116
ROCKVILLE CENTRE NY
11570-3761
US

IV. Provider business mailing address

165 N VILLAGE AVE SUITE 116
ROCKVILLE CENTRE NY
11570-3761
US

V. Phone/Fax

Practice location:
  • Phone: 516-763-3040
  • Fax: 516-763-4325
Mailing address:
  • Phone: 516-763-3040
  • Fax: 516-763-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALLEN ROTHPEARL
Title or Position: OWNER
Credential: MD
Phone: 516-763-3040