Provider Demographics
NPI:1447516554
Name:WEST SIDE RADIOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:WEST SIDE RADIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GHESANI MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-523-7049
Mailing Address - Street 1:10 EXCHANGE PL
Mailing Address - Street 2:14TH FLOOR - WSBS
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3918
Mailing Address - Country:US
Mailing Address - Phone:201-830-3200
Mailing Address - Fax:201-200-0838
Practice Address - Street 1:309 W 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2202
Practice Address - Country:US
Practice Address - Phone:212-256-7016
Practice Address - Fax:212-256-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03474471Medicaid
NYW00691Medicare PIN