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General NPI Number Information
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NPI Number | 1619943495
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Entity Type | Organization
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Legal Business Name | ISLAND DIAGNOSTIC IMAGING ASSOCIATES
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 4160 MERRICK RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-797-6700
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Fax | 516-797-8463
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Provider Business Mailing Address
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Address Line | 4160 MERRICK RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758
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Country | US
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Telephone | 516-797-6700
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Fax | 516-797-8463
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEVEN MARK PEYSER
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Credential | MD
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Telephone | 516-797-6700
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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 | 29022743
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License Number State | NY
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