MEDICARE: DIAGNOSTIC RADIOLOGY CENTER OF THE TREASURE COAST

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1659441236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC RADIOLOGY CENTER OF THE TREASURE COAST

Provider Business Mailing Address
First Line	:	2011 SOUTH 25TH ST
Second Line	:	SUITE 106
City	:	FT PIERCE
State	:	FL
Zip	:	34947
Country	:	US
Telephone Number	:	772-468-7020
Fax Number	:	772-468-7698

Provider Business Practice Location Address
First Line	:	2011 SOUTH 25TH ST
Second Line	:	SUITE 106
City	:	FT PIERCE
State	:	FL
Zip	:	34947
Country	:	US
Telephone Number	:	772-468-7020
Fax Number	:	772-468-7698

Authorized Official
Title or Position	:	PRESIDENT MD
Name	:	AJAY KUMAR GOYAL
Credential	:	MD
Telephone Number	:	772-468-7020

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/22/2020

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