=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659659076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPERT RADIOLOGY IMAGING, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2011
-----------------------------------------------------
Last Update Date | 08/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 630 1ST AVE SUITE 30 L
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-3700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-903-2762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 630 1ST AVE SUITE 30 L
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-3700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-903-2762
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AMI ARVINDRAY SHAH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-903-2762
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number | 201763
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | 201763
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------