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General NPI Number Information
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NPI Number | 1821180159
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Entity Type | Organization
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Legal Business Name | STAND-UP MRI OF DEER PARK, P.C.
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 1118 DEER PARK AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-3102
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Country | US
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Telephone | 631-243-3222
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Fax | 631-243-3355
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Provider Business Mailing Address
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Address Line | PO BOX 170
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City | FARMINGDALE
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State | NY
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Zip | 11735-0170
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Country | US
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Telephone | 631-396-1050
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Fax | 631-396-1056
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN M HERSHOWITZ
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Credential | M.D.
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Telephone | 631-396-1050
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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 |
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