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Organization

PROSPECT MEDICAL IMAGING P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. DENISE RICHARD M.D. (PRESIDENT)
(347) 512-1716
Entity
Organization

Contact information

Practice address
586 MIDLAND AVE, STE 2C, STATEN ISLAND, NY 10306-5903
(347) 512-1716
Mailing address
586 MIDLAND AVE, STE 2C, STATEN ISLAND, NY 10306-5903
(347) 512-1716

Taxonomy

Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
157428
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
157428
LIC
NY
Enumeration date
10/26/2016
Last updated
10/26/2016
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