Basic Information
| Provider Information | |||||||||
| NPI: | 1114047305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DORSTEN RADIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 666 GREENWICH ST | ||||||||
| Address2: | #843 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100146329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129298619 | ||||||||
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| Practice Location | |||||||||
| Address1: | 217 E 7TH ST | ||||||||
| Address2: | SUITE 7D | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112182650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186045000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | DORSTEN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | DO | ||||||||
| AuthorizedOfficialTelephone: | 2129298619 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 62589 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 01640284 | 05 | NY | MEDICAID |