MEDICARE: MADISON AVENUE RADIOLOGY PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1184852741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON AVENUE RADIOLOGY PC

Provider Business Mailing Address
First Line	:	22 MERIDIAN RD
Second Line	:	STE 7
City	:	EDISON
State	:	NJ
Zip	:	08820-2860
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3829
Country	:	US
Telephone Number	:	212-860-3500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SATISH CHANDRA
Credential	:	MD
Telephone Number	:	212-860-3500

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/22/2009

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