NPIMap

Organization Active NPI

Stand-Up MRI of Melville, PC

  • Diagnostic Radiology Physician
  • Melville, NY
National Provider Identifier
1457326506
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
STAND-UP MRI OF MELVILLE, PC
Practice address
110 Marcus Dr
Melville, NY 11747-4228
Phone
(631) 454-0539
Fax
(631) 454-9190
NPI assigned
Feb 22, 2006
Last updated
Jun 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Lloyd Waxman
Title
Director of Operations
Phone
(631) 694-2816

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

110 Marcus Dr
Melville, NY 11747-4228

Mailing address

110 Marcus Dr
Melville, NY 11747-4228
Phone (631) 454-0539

Other identifiers 1

IdentifierTypeStateIssuer
02915997MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318001588 NY Part B Supplier - Clinic/Group Practice 5496645756 Receives reassigned benefits from 22 practitioners
Practice locations: Melville, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1457326506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 MARCUS DR",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474228",
            "telephone_number": "631-454-0539",
            "fax_number": "631-454-9190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MARCUS DR",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117474228",
            "telephone_number": "631-454-0539",
            "fax_number": "631-454-9190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAND-UP MRI OF MELVILLE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "WAXMAN",
        "authorized_official_first_name": "LLOYD",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "631-694-2816"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02915997",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.