NPIMap

Organization Active NPI

Distinguished Diagnostic Imaging P.C.

  • Multi-Specialty Clinic/Center
  • Bronx, NY
National Provider Identifier
1306061890
Registry record updated Nov 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
50009328 Issued in NY
Legal business name
DISTINGUISHED DIAGNOSTIC IMAGING P.C.
Practice address
1484 Williamsbridge Rd
Bronx, NY 10461-2505
Phone
(718) 828-6800
NPI assigned
Apr 17, 2007
Last updated
Nov 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2008

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

Authorized official

Name
Mr. Joel Reisman
Title
Administrator
Phone
(718) 828-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 50009328 NY Primary

Addresses

Primary practice location

1484 Williamsbridge Rd
Bronx, NY 10461-2505

Mailing address

1484 Williamsbridge Rd
Bronx, NY 10461-2505
Phone (718) 828-6800

Other identifiers 1

IdentifierTypeStateIssuer
00901271MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000542 NY Part B Supplier - Clinic/Group Practice 9739079906 Receives reassigned benefits from 20 practitioners
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory

Locations

1484 Williamsbridge Rd
Bronx, NY 10461
Phone (718) 828-6800

1957 Williamsbridge Rd
Bronx, NY 10461
Phone (718) 828-6060

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226534400000",
    "number": "1306061890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1484 WILLIAMSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612505",
            "telephone_number": "718-828-6800",
            "fax_number": "718-228-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1484 WILLIAMSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612505",
            "telephone_number": "718-828-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTINGUISHED DIAGNOSTIC IMAGING P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-11-13",
        "status": "A",
        "authorized_official_last_name": "REISMAN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "718-828-6800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NY",
            "license": "50009328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00901271",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; 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.