Individual
KEI DOI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
3839 DANBURY RD, NORTHEAST RADIOLOGY, BREWSTER, NY 10509-5412
(845) 278-6200
(845) 278-1613
Mailing address
3839 DANBURY RD, NORTHEAST RADIOLOGY, BREWSTER, NY 10509-5412
(845) 278-6200
(845) 278-7802
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
237485
NY
2085N0700X
Neuroradiology Physician
237485
NY
2085N0904X
Nuclear Radiology Physician
237485
NY
2085P0229X
Pediatric Radiology Physician
237485
NY
2085R0202X
Diagnostic Radiology Physician
Primary
237485
NY
2085U0001X
Diagnostic Ultrasound Physician
23745
NY
Other
Enumeration date
11/21/2005
Last updated
03/31/2016
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