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General NPI Number Information
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NPI Number | 1710996509
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Entity Type | Organization
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Legal Business Name | MOSHOLU PARK RADIOLOGY PC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | MOSHOLU PARK RADIOLOGY PC 3130 GRAND CONCOURSE STE 1P
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City | BRONX
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State | NY
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Zip | 10458
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Country | US
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Telephone | 718-933-6969
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Fax | 718-933-6970
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Provider Business Mailing Address
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Address Line | MOSHOLU PARK RADIOLOGY PC 3130 GRAND CONCOURSE STE 1P
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City | BRONX
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State | NY
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Zip | 10458
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Country | US
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Telephone | 718-933-6969
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Fax | 718-933-6970
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDRESITO B PACIS
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Credential | MD
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Telephone | 718-933-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 1252131
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 1252131
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | 1252131
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License Number State | NY
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