Provider Demographics
NPI:1649332107
Name:COMPLETE WOMEN'S IMAGING, PC
Entity type:Organization
Organization Name:COMPLETE WOMEN'S IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-222-4855
Mailing Address - Street 1:990 STEWART AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-222-4294
Mailing Address - Fax:516-222-4885
Practice Address - Street 1:990 STEWART AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-222-4294
Practice Address - Fax:516-222-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085B0100X
NY2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWTS351Medicare PIN