Basic Information
| Provider Information | |||||||||
| NPI: | 1912251448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPIRE RADIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 N HILLSIDE PL | ||||||||
| Address2: | |||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074503027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073242340 | ||||||||
| FaxNumber: | 6073247615 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 N HILLSIDE PL | ||||||||
| Address2: | |||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074503027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073242340 | ||||||||
| FaxNumber: | 6073247615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2012 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | LOSECCO | ||||||||
| AuthorizedOfficialFirstName: | LYNDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6073242340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085U0001X | 25MA07998700 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
No ID Information.