MEDICARE: RELIABLE RADIOGRAPHICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C3402X	Radiography Radiologic Technologist	5605	FL

General Provider Information

NPI Number	:	1538196464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE RADIOGRAPHICS

Provider Business Mailing Address
First Line	:	4377 ROCK ISLAND RD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4520
Country	:	US
Telephone Number	:	954-733-5008
Fax Number	:	954-731-5222

Provider Business Practice Location Address
First Line	:	4377 ROCK ISLAND RD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4520
Country	:	US
Telephone Number	:	954-733-5008
Fax Number	:	954-731-5222

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ISIDORE ANTONOFF
Credential	:
Telephone Number	:	954-733-5008

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/22/2020

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