NPIMap

Organization Active NPI

Main Street Radiology at Bayside LLC

  • Diagnostic Radiology Physician
  • Glendale, NY
National Provider Identifier
1851893317
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MAIN STREET RADIOLOGY AT BAYSIDE LLC
Practice address
8314 Cooper Ave
Glendale, NY 11385-7722
Phone
(718) 428-1500
Fax
(718) 907-2389
NPI assigned
Mar 1, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Authorized official

Name
Ari M Jonisch, MD
Title
Authorized Official
Phone
(718) 428-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

8314 Cooper Ave
Glendale, NY 11385-7722

Mailing address

3225 Francis Lewis Blvd
Flushing, NY 11358-1922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040428001019 NY Part B Supplier - Clinic/Group Practice 5395732671 Receives reassigned benefits from 69 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20181029000570 CT Part B Supplier - Clinic/Group Practice 5395732671 Receives reassigned benefits from 4 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ridgefield, CT; Weston, CT; Greenwich, CT

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Main Street Radiology at Bayside LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8314 Cooper Ave
Glendale, NY 11385

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1851893317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 FRANCIS LEWIS BLVD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113581922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8314 COOPER AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857722",
            "telephone_number": "718-428-1500",
            "fax_number": "718-907-2389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET RADIOLOGY AT BAYSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "JONISCH",
        "authorized_official_first_name": "ARI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "718-428-1500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 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.