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General NPI Number Information
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NPI Number | 1225069149
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Entity Type | Organization
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Legal Business Name | SLR DIAGNOSTIC RADIOLOGY, P.C.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVE DEPT OF RADIOLOGY
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone | 201-830-3122
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Fax | 201-200-0838
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Provider Business Mailing Address
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Address Line | PO BOX 10269
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City | UNIONDALE
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State | NY
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Zip | 11555-0269
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Country | US
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Telephone | 201-830-3122
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Fax | 201-200-0838
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEANNE BAER
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Credential | MD
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Telephone | 201-830-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0205X
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Taxonomy Name | Radiological Physics Physician
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License Number |
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License Number State |
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