Organization
SR MEDICAL RADIOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LODESPOTO (OWNER)
(718) 848-7142
Entity
Organization
Contact information
Practice address
2529 87TH ST, EAST ELMHURST, NY 11369-1020
(718) 848-7142
(718) 848-7153
Mailing address
2529 87TH ST, EAST ELMHURST, NY 11369-1020
(718) 848-7142
(718) 848-7153
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
171063
NY
2085U0001X
Diagnostic Ultrasound Physician
171063
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01418331
—
NY
Enumeration date
04/24/2012
Last updated
04/24/2012
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