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General NPI Number Information
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NPI Number | 1265794853
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Entity Type | Organization
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Legal Business Name | PARK PLACE MEDICAL IMAGING P.C.
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 316 E 30TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-8366
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Country | US
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Telephone | 212-380-2075
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Fax | 212-380-2076
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Provider Business Mailing Address
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Address Line | 101 W 24TH ST APT 28H
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City | NEW YORK
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State | NY
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Zip | 10011-1909
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Country | US
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Telephone | 212-380-2075
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Fax | 212-380-2076
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LISA A CORRENTE
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Credential | M.D.
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Telephone | 212-380-2075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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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 | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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