Healthcare Provider Details

I. General information

NPI: 1184888745
Provider Name (Legal Business Name): HEALTHCARE ASSOCIATES IN MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COLUMBUS AVE
STATEN ISLAND NY
10304
US

IV. Provider business mailing address

2535 ARTHUR KILL RD
STATEN ISLAND NY
10309-1207
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-3210
  • Fax: 718-816-9288
Mailing address:
  • Phone: 718-448-3210
  • Fax: 718-984-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL I BERKLEY
Title or Position: ADMINISTRATOR
Credential: CMPE
Phone: 718-448-3210