Active NPI
Kimberly D. Zedalis
- Radiology Practitioner Assistant
- Lake Grove, NY
National Provider Identifier
1124276282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Practitioner Assistant
- License
- 000142
- Practice address
- 2780 Middle Country Rd
Ste 210
Lake Grove, NY 11755-2124 - Phone
- (631) 588-4500
- Fax
- (631) 588-4595
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiologic Technologist | 247100000X | 956080 | NY | |
| Mammography Radiologic Technologist | 2471M2300X | 956080 | NY | |
| Radiology Practitioner Assistant | 243U00000X | 000142 | NY | Primary |
Addresses
Primary practice location
2780 Middle Country Rd
Ste 210
Lake Grove, NY 11755-2124
Mailing address
2780 Middle Country Rd
Ste 210
Lake Grove, NY 11755-2124
Phone (631) 588-4500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000142 | NY | MD | Radiology Practitioner Assistant |
| 956080 | NY | MD | Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222819200000",
"number": "1124276282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2780 MIDDLE COUNTRY RD",
"address_2": "STE 210",
"city": "LAKE GROVE",
"state": "NY",
"postal_code": "117552124",
"telephone_number": "631-588-4500",
"fax_number": "631-588-4595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2780 MIDDLE COUNTRY RD",
"address_2": "STE 210",
"city": "LAKE GROVE",
"state": "NY",
"postal_code": "117552124",
"telephone_number": "631-588-4500",
"fax_number": "631-588-4595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZEDALIS",
"first_name": "KIMBERLY",
"middle_name": "D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-03",
"last_updated": "2008-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "247100000X",
"taxonomy_group": "",
"desc": "Radiologic Technologist",
"state": "NY",
"license": "956080",
"primary": false
},
{
"code": "2471M2300X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Mammography",
"state": "NY",
"license": "956080",
"primary": false
},
{
"code": "243U00000X",
"taxonomy_group": "",
"desc": "Radiology Practitioner Assistant",
"state": "NY",
"license": "000142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Grove, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.