Healthcare Provider Details

I. General information

NPI: 1124335278
Provider Name (Legal Business Name): ZWANGER RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG 15
STONY BROOK NY
11790-2555
US

IV. Provider business mailing address

2500 NESCONSET HWY BLDG 15
STONY BROOK NY
11790-2555
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-2900
  • Fax: 631-751-2051
Mailing address:
  • Phone: 631-751-2900
  • Fax: 631-751-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number145241
License Number StateNY

VIII. Authorized Official

Name: MS. PATRICIA M FORTE
Title or Position: DIRECTOR OF CONTRACTING/CREDENTIALI
Credential:
Phone: 631-930-9422