NPIMap

Organization Active NPI

DP Radiology Imaging PC

  • Diagnostic Radiology Physician
  • Staten Island, NY
National Provider Identifier
1417790098
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
DP RADIOLOGY IMAGING PC
Practice address
586 Midland Ave Ste B
Staten Island, NY 10306-5903
Phone
(347) 730-4606
Fax
(888) 500-0406
NPI assigned
Jun 13, 2024
Last updated
Jun 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Dmitry Pekarsky, MDNPI 1952619686
Title
Owner
Phone
(917) 482-6555

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
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

586 Midland Ave Ste B
Staten Island, NY 10306-5903

Mailing address

7119 168TH St
Fresh Meadows, NY 11365-3241
Phone (347) 730-4606

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240924001472 NY Part B Supplier - Clinic/Group Practice 0840731378 Receives reassigned benefits from 1 practitioner
Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory

Locations

586 Midland Ave
Ste B
Staten Island, NY 10306
Phone (347) 201-5081

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1417790098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7119 168TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653241",
            "telephone_number": "347-730-4606",
            "fax_number": "888-500-0406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "586 MIDLAND AVE STE B",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103065903",
            "telephone_number": "347-730-4606",
            "fax_number": "888-500-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DP RADIOLOGY IMAGING PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "PEKARSKY",
        "authorized_official_first_name": "DMITRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-482-6555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.