MEDICARE: STAND-UP MRI OF DEER PARK, 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

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	:	1821180159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAND-UP MRI OF DEER PARK, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 170
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-0170
Country	:	US
Telephone Number	:	631-396-1050
Fax Number	:	631-396-1056

Provider Business Practice Location Address
First Line	:	1118 DEER PARK AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-3102
Country	:	US
Telephone Number	:	631-243-3222
Fax Number	:	631-243-3355

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN M HERSHOWITZ
Credential	:	M.D.
Telephone Number	:	631-396-1050

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/13/2012

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