Contract Details
Facility name
Marine Park Radiology, PC
Provider ID
P000003708
NPI
1053362699
Tax ID
113214659
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
2270 Kimball St Suite 102
Brooklyn, NY 11234
United States
County
Kings
Phone
7182536616 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address