=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922551027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULL FRAME RADIOLOGY & DIAGNOSTIC IMAGING GROUP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2016
-----------------------------------------------------
Last Update Date | 07/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13237 POPLE AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-693-1312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 270
-----------------------------------------------------
City | MASSAPEQUA PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11762-0270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-264-2035
-----------------------------------------------------
Fax | 631-264-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND DIRECTOR
-----------------------------------------------------
Name | WILLIAM W QIU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-693-1312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------