Basic Information
| Provider Information | |||||||||
| NPI: | 1659841013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDTOWN WEST RADIOLOGY P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 21858 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100871858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9294809100 | ||||||||
| FaxNumber: | 8778887955 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 SEACOAST TERRACE | ||||||||
| Address2: | #20N | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9294809100 | ||||||||
| FaxNumber: | 8778887955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| AuthorizedOfficialLastName: | HIKIN | ||||||||
| AuthorizedOfficialFirstName: | DIMITRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9294809100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O, | ||||||||
| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.