Basic Information
| Provider Information | |||||||||
| NPI: | 1467780981 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLAGE OPEN MRI | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FIVE TOWNS NEUROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 ROCKAWAY TPKE | ||||||||
| Address2: | |||||||||
| City: | CEDARHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115161833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162391800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 222 ROCKAWAY TPKE | ||||||||
| Address2: | |||||||||
| City: | CEDARHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115161833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162391800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2009 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BEYDA | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | RADIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5162391800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 219543 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.