MEDICARE: WESTSIDE RADIOLOGY ASSOCIATES, 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	H98008230778	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	:	1477865558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE RADIOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	215 EAST 95TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-4077
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 EXCHANGE PLACE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3918
Country	:	US
Telephone Number	:	201-830-3200
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. MUNIR GHESANI
Credential	:	M.D.
Telephone Number	:	212-523-7049

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	12/28/2010

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