NPIMap

Organization Active NPI

Shore Road Radiology Associates, PC

  • Diagnostic Radiology Physician
  • Brooklyn, NY
National Provider Identifier
1811903578
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
16820 Issued in NY
Legal business name
SHORE ROAD RADIOLOGY ASSOCIATES, PC
Practice address
150 55TH St
Brooklyn, NY 11220-2559
Phone
(718) 630-7477
Fax
(718) 630-7437
NPI assigned
Aug 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

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

Authorized official

Name
Mr. Gary Dellacerra, V.P.
Title
VP Managed Care & Revenue Complianc
Phone
(718) 630-7103

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085N0904X 16820 NY
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X 16820 NY Primary
Vascular & Interventional Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0204X 16820 NY
Diagnostic Ultrasound PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085U0001X 16820 NY

Addresses

Primary practice location

150 55TH St
Brooklyn, NY 11220-2559

Mailing address

5800 3Rd Ave
Lutheran Medical Center-Managed Care Department
Brooklyn, NY 11220-3702
Phone (718) 630-7477

Other identifiers 1

IdentifierTypeStateIssuer
00809412MedicaidNY

National Provider Directory

National Provider Directory

Locations

5800 3rd Ave
Brooklyn, NY 11220
Phone (718) 630-6180

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220832000000",
    "number": "1811903578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 3RD AVE",
            "address_2": "LUTHERAN MEDICAL CENTER-MANAGED CARE DEPARTMENT",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203702",
            "telephone_number": "718-630-7477",
            "fax_number": "718-630-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 55TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202559",
            "telephone_number": "718-630-7477",
            "fax_number": "718-630-7437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE ROAD RADIOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-09-08",
        "status": "A",
        "authorized_official_last_name": "DELLACERRA",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "VP MANAGED CARE & REVENUE COMPLIANC",
        "authorized_official_telephone_number": "718-630-7103",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "V.P."
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": "NY",
            "license": "16820",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "16820",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NY",
            "license": "16820",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "NY",
            "license": "16820",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00809412",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.