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General NPI Number Information
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NPI Number | 1962576199
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Entity Type | Organization
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Legal Business Name | THIRD AVENUE RADIOLOGY & IMAGING PC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2781 3RD AVE
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City | BRONX
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State | NY
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Zip | 10455-4002
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Country | US
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Telephone | 718-402-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 2781 3RD AVE
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City | BRONX
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State | NY
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Zip | 10455-4002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KENNETH GLEICHER
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Credential |
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Telephone | 718-402-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 140221-1
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License Number State | NY
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