=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104161652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NS RADIOLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2012
-----------------------------------------------------
Last Update Date | 12/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 2ND AVE SUITE 306
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-375-1438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 2ND AVE SUITE 306
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10010-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | NORMAN Y SCHOENBERG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-375-1438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 169883
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------