Organization Active NPI

Radiology Medical Associates PC

  • Diagnostic Radiology Physician
  • Rego Park, NY
National Provider Identifier
1740536044
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY MEDICAL ASSOCIATES PC
Practice address
97-28 63Rd Road
Rego Park, NY 11374-1639
Phone
(718) 539-3646
Fax
(888) 500-0406
NPI assigned
Jul 24, 2012
Last updated
Aug 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Authorized official

Name
Mr. Neal Lisann, MDNPI 1528027067
Title
Owner
Phone
(347) 730-4606

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X 261994-1 NY
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

97-28 63Rd Road
Rego Park, NY 11374-1639

Mailing address

6923 168TH Street
Fresh Meadows, NY 11365-3213
Phone (718) 539-3646

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130228000152 NY Part B Supplier - Clinic/Group Practice 0840441796 Receives reassigned benefits from 4 practitioners
Practice locations: Rego Park, NY; Staten Island, NY

National Provider Directory

National Provider Directory

Locations

265 Canal St
Ste 205
New York, NY 10013
Phone (212) 966-6558

9726 63rd Rd
Rego Park, NY 11374

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1740536044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6923 168TH STREET",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653213",
            "telephone_number": "718-539-3646",
            "fax_number": "888-500-0406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97-28 63RD ROAD",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741639",
            "telephone_number": "718-539-3646",
            "fax_number": "888-500-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY MEDICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "LISANN",
        "authorized_official_first_name": "NEAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-730-4606",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "261994-1",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.