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General NPI Number Information
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NPI Number | 1396857843
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Entity Type | Organization
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Legal Business Name | MID-ISLAND MEDICAL IMAGING, P.C.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 1643C ROUTE 112
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City | MEDFORD
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State | NY
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Zip | 11763
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Country | US
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Telephone | 631-758-1800
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Fax | 631-758-8029
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Provider Business Mailing Address
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Address Line | 1643C ROUTE 112
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City | MEDFORD
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State | NY
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Zip | 11763
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Country | US
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Telephone | 631-758-1800
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Fax | 631-758-8029
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ALEXANDRA B PERKINS
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Credential | M.D.
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Telephone | 631-758-1800
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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 | 51016723
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License Number State | NY
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