MEDICARE: XXI CENTURY RADIOLOGY AND CARDIAC IMAGING 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

General Provider Information

NPI Number	:	1790861730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	XXI CENTURY RADIOLOGY AND CARDIAC IMAGING PC

Provider Business Mailing Address
First Line	:	3046 OCEAN PARK WAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205
Country	:	US
Telephone Number	:	718-236-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3046 OCEAN PARK WAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205
Country	:	US
Telephone Number	:	718-236-1000
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. VANESSA FERA
Credential	:
Telephone Number	:	718-236-1000

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	08/22/2020

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