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General NPI Number Information
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NPI Number | 1124335278
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Entity Type | Organization
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Legal Business Name | ZWANGER RADIOLOGY, PC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 15
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-751-2900
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Fax | 631-751-2051
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 15
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-751-2900
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Fax | 631-751-2051
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Authorized Official
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Title or Position | DIRECTOR OF CONTRACTING/CREDENTIALI
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Name | MS. PATRICIA M FORTE
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Credential |
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Telephone | 631-930-9422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 145241
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License Number State | NY
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