MEDICARE: MARINE PARK RADIOLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085N0700X	Neuroradiology Physician
2	2085U0001X	Diagnostic Ultrasound Physician
3	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053362699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINE PARK RADIOLOGY PC

Provider Business Mailing Address
First Line	:	2270 KIMBALL STREET
Second Line	:	STE 102
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-253-6616
Fax Number	:	718-253-7059

Provider Business Practice Location Address
First Line	:	2270 KIMBALL STREET
Second Line	:	STE 102
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-253-6616
Fax Number	:	718-253-7059

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	HAROLD R TANENBAUM
Credential	:	M.D.
Telephone Number	:	718-253-6616

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	11/04/2024

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