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General NPI Number Information
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NPI Number | 1124655352
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Entity Type | Organization
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Legal Business Name | IMAGING SUBSPECIALIST OF NEW YORK
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 110 CRYSTAL RUN RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-4040
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Country | US
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Telephone | 845-673-6446
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Fax |
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Provider Business Mailing Address
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Address Line | 285 RIVER RD
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City | NYACK
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State | NY
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Zip | 10960-5001
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Country | US
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Telephone | 646-407-2044
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VINCENT GRAZIANO
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Credential | MD
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Telephone | 646-407-2044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number |
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License Number State |
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