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General NPI Number Information
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NPI Number | 1962492546
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Entity Type | Organization
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Legal Business Name | GOETHALS RADIOLOGY PC
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 475 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3436
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Country | US
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Telephone | 718-226-9175
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Fax | 718-876-3462
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Provider Business Mailing Address
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Address Line | PO BOX 4652
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City | WARREN
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State | NJ
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Zip | 07059-0652
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Country | US
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Telephone | 718-226-9175
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Fax | 718-876-3462
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHALOM BUCHBINDER
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Credential | MD
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Telephone | 718-226-9175
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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 | 6050006
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License Number State | NY
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