Provider Demographics
NPI:1174884191
Name:IS RADIOLOGY PLLC
Entity type:Organization
Organization Name:IS RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LODISPOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-446-4700
Mailing Address - Street 1:1201 ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8001
Mailing Address - Country:US
Mailing Address - Phone:631-446-4700
Mailing Address - Fax:631-446-4701
Practice Address - Street 1:1201 ROUTE 112
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-8001
Practice Address - Country:US
Practice Address - Phone:631-446-4700
Practice Address - Fax:631-446-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1710632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty