Basic Information
| Provider Information | |||||||||
| NPI: | 1477523413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ZWANGER & PESIRI RADIOLOGY GROUP, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 E SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | LINDENHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117572598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312257200 | ||||||||
| FaxNumber: | 6319309451 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 E SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | LINDENHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117572598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312257200 | ||||||||
| FaxNumber: | 6319309451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | MENDELSOHN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6312257200 | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 00418942 | 05 | NY | MEDICAID |