Healthcare Provider Details

I. General information

NPI: 1174802391
Provider Name (Legal Business Name): ONSITE IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 VULCAN ST
STATEN ISLAND NY
10305-3517
US

IV. Provider business mailing address

33 VULCAN ST
STATEN ISLAND NY
10305-3517
US

V. Phone/Fax

Practice location:
  • Phone: 718-612-9292
  • Fax: 201-484-8485
Mailing address:
  • Phone: 718-612-9292
  • Fax: 201-484-8485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIOLETTA CHOSTAK
Title or Position: OWNER
Credential:
Phone: 718-612-9292