MEDICARE: RADIOLOGY OF NEW YORK 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	2085R0202X	Diagnostic Radiology Physician
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	25MA03219200	NJ

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	:	1669455457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY OF NEW YORK P.C.

Provider Business Mailing Address
First Line	:	9705 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-848-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	9705 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-848-0606
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. OLEKS GOLO
Credential	:
Telephone Number	:	718-848-0606

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	10/24/2007

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