Organization Active NPI

Richmond Hill Radiology, P.C.

  • Radiology Clinic/Center
  • Richmond Hill, NY
National Provider Identifier
1174586879
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
196198-1 Issued in NY
Legal business name
RICHMOND HILL RADIOLOGY, P.C.
Practice address
11614 Myrtle Ave
Richmond Hill, NY 11418-1748
Phone
(718) 846-0606
Fax
(718) 846-8684
NPI assigned
Apr 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wen Yi Wang, M.D.NPI 1063476414
Title
Medical Director
Phone
(718) 846-0606

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 196198-1 NY Primary

Addresses

Primary practice location

11614 Myrtle Ave
Richmond Hill, NY 11418-1748

Mailing address

11614 Myrtle Ave
Richmond Hill, NY 11418-1748
Phone (718) 846-0606

Other identifiers 1

IdentifierTypeStateIssuer
1854517MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050421000390 NY Part B Supplier - Clinic/Group Practice 5890733711 Receives reassigned benefits from 2 practitioners
Practice locations: Flushing, NY; Richmond Hill, NY

National Provider Directory

National Provider Directory

Locations

4125 Kissena Blvd
Ste 122
Flushing, NY 11355
Phone (718) 321-2849

11614 Myrtle Ave
Richmond Hill, NY 11418
Phone (718) 846-0606

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1174586879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11614 MYRTLE AVE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "114181748",
            "telephone_number": "718-846-0606",
            "fax_number": "718-846-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11614 MYRTLE AVE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "114181748",
            "telephone_number": "718-846-0606",
            "fax_number": "718-846-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHMOND HILL RADIOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "WEN",
        "authorized_official_middle_name": "YI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "718-846-0606",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NY",
            "license": "196198-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1854517",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond Hill, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.