MEDICARE: NEW IMAGE INTERVENTIONAL RADIOLOGY, PLLC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1801197603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW IMAGE INTERVENTIONAL RADIOLOGY, PLLC

Provider Business Mailing Address
First Line	:	1351 ROUTE 55
Second Line	:	FIRST FLOOR
City	:	LAGRANGEVILLE
State	:	NY
Zip	:	12540-5108
Country	:	US
Telephone Number	:	845-454-8700
Fax Number	:	845-790-5719

Provider Business Practice Location Address
First Line	:	169 MYERS CORNERS RD
Second Line	:	SUITE 250
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-3867
Country	:	US
Telephone Number	:	845-454-4700
Fax Number	:	845-790-5719

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. PHILIP AMATULLE
Credential	:	M.D.
Telephone Number	:	845-454-8700

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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