Organization
NORTH SHORE REGIONAL MRI PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTO ANTONACCI M.D. (PRESIDENT)
(631) 588-4500
Entity
Organization
Contact information
Practice address
2780 MIDDLE COUNTRY ROAD, SUITE 305, LAKE GROVE, NY 11755
(631) 689-5252
(631) 689-5934
Mailing address
2780 MIDDLE COUNTRY ROAD, SUITE 305, LAKE GROVE, NY 11755
(631) 588-4500
(631) 588-4595
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/02/2005
Last updated
10/07/2014
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