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General NPI Number Information
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NPI Number | 1528283140
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Entity Type | Organization
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Legal Business Name | SMITHTOWN RADIOLOGY PC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 301 MAPLE AVE
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-724-7700
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Fax | 631-724-0195
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Provider Business Mailing Address
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Address Line | 301 MAPLE AVE
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-724-7700
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Fax | 631-724-0195
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN D KREMER
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Credential | MD
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Telephone | 631-724-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 146436
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License Number State | NY
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