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General NPI Number Information
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NPI Number | 1760615793
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Entity Type | Organization
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Legal Business Name | SUFFOLK MEDICAL IMAGING, PC
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 2780 MIDDLE COUNTRY ROAD SUITE 210
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City | LAKE GROVE
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State | NY
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Zip | 11755
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Country | US
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Telephone | 631-588-4500
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Fax | 631-588-4595
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Provider Business Mailing Address
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Address Line | 2780 MIDDLE COUNTRY ROAD SUITE 210
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City | LAKE GROVE
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State | NY
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Zip | 11755
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Country | US
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Telephone | 631-588-4500
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Fax | 631-588-4595
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT ANTONACCI
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Credential | MD
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Telephone | 631-588-4500
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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 |
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License Number State | NY
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