1659682185 NPI number — RADIOLOGY ADVANCED DIAGNOSTICS, LLC

Table of content: (NPI 1659682185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659682185 NPI number — RADIOLOGY ADVANCED DIAGNOSTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ADVANCED DIAGNOSTICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659682185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16361 VIA FONTANA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-6496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-789-9587
Provider Business Mailing Address Fax Number:
561-995-8635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 N STATE ROAD 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-209-6083
Provider Business Practice Location Address Fax Number:
561-209-6084
Provider Enumeration Date:
06/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER. PRESIDENT
Authorized Official Telephone Number:
561-789-9587

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME0041195 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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