Basic Information
| Provider Information | |||||||||
| NPI: | 1194702282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMORIAL NUCLEAR MEDICINE GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 633 3RD AVE | ||||||||
| Address2: | BOX 3 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100176706 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1275 YORK AVE | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100216007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126392000 | ||||||||
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| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 04/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | ANDREOZZI | ||||||||
| AuthorizedOfficialFirstName: | SALVATORE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6462273751 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine |
No ID Information.