Provider Demographics
NPI:1487649042
Name:S I PORTABLE X-RAY SVC INC
Entity type:Organization
Organization Name:S I PORTABLE X-RAY SVC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LRT
Authorized Official - Phone:718-948-5344
Mailing Address - Street 1:488 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5833
Mailing Address - Country:US
Mailing Address - Phone:718-948-5344
Mailing Address - Fax:718-948-2654
Practice Address - Street 1:488 ARBUTUS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5833
Practice Address - Country:US
Practice Address - Phone:718-948-5344
Practice Address - Fax:718-948-2654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018019093Medicaid
NY018019093Medicaid