Basic Information
| Provider Information | |||||||||
| NPI: | 1922551027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FULL FRAME RADIOLOGY & DIAGNOSTIC IMAGING GROUP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 270 | ||||||||
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| City: | MASSAPEQUA PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117620270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312642035 | ||||||||
| FaxNumber: | 6312641418 | ||||||||
| Practice Location | |||||||||
| Address1: | 13237 POPLE AVE | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113554448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326931312 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2016 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | QIU | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER AND DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7326931312 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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.