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NPI Code Detail

MEDICARE: MAIN STREET RADIOLOGY AT BAYSIDE LLC

MEDICARE: MAIN STREET RADIOLOGY AT BAYSIDE LLC
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
12085R0202XDiagnostic Radiology Physician

Other Identifiers

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

General Provider Information

NPI Number : 1598852469
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAIN STREET RADIOLOGY AT BAYSIDE LLC
Provider Business Mailing Address
First Line : 3211 FRANCIS LEWIS BLVD
Second Line :
City : FLUSHING
State : NY
Zip : 11358-1922
Country : US
Telephone Number : 718-352-9850
Fax Number : 718-352-0102
Provider Business Practice Location Address
First Line : 4401 FRANCIS LEWIS BLVD
Second Line :
City : BAYSIDE
State : NY
Zip : 11361-3002
Country : US
Telephone Number : 718-428-1500
Fax Number : 718-352-0292
Authorized Official
Title or Position : OFFICER
Name : DR. ARI JONISCH
Credential : M.D.
Telephone Number : 718-428-1500
Provider Enumeration Date : 10/10/2006
Last Update Date : 11/03/2022

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Directions to “MAIN STREET RADIOLOGY AT BAYSIDE LLC ” Practice Location

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