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1255508073

NPI Code Detail

MEDICARE: SLR DIAGNOSTIC RADIOLOGY, P.C.

MEDICARE: SLR DIAGNOSTIC RADIOLOGY, P.C.

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	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician		NY
2	2085N0700X	Neuroradiology Physician		NY
3	2085B0100X	Body Imaging Physician		NY
4	2085N0904X	Nuclear Radiology Physician		NY
5	2085P0229X	Pediatric Radiology Physician		NY
6	2085R0204X	Vascular & Interventional Radiology Physician		NY
7	2085R0205X	Radiological Physics Physician		NY
8	2085U0001X	Diagnostic Ultrasound Physician		NY
9	2085R0202X	Diagnostic Radiology Physician		NY

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	:	1255508073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLR DIAGNOSTIC RADIOLOGY, P.C.

Provider Business Mailing Address
First Line	:	10 EXCHANGE PL
Second Line	:	14TH FLOOR WSBS
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3918
Country	:	US
Telephone Number	:	201-830-3122
Fax Number	:	201-200-0838

Provider Business Practice Location Address
First Line	:	3201 KINGS HWY
Second Line	:	DEPT OF RADIOLOGY
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2625
Country	:	US
Telephone Number	:	718-951-2930
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JEANNE BAER
Credential	:	M.D.
Telephone Number	:	201-830-3122

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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Directions to “SLR DIAGNOSTIC RADIOLOGY, P.C. ” Practice Location

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