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NPI Code Detail

MEDICARE: PEMBROKE WEST DIAGNOSTIC IMAGING INC

MEDICARE: PEMBROKE WEST DIAGNOSTIC IMAGING INC
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
1261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center
2261QM1300XMulti-Specialty Clinic/Center
3261QR0200XRadiology Clinic/Center

General Provider Information

NPI Number : 1689706863
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEMBROKE WEST DIAGNOSTIC IMAGING INC
Provider Business Mailing Address
First Line : 11011 SHERIDAN ST
Second Line : SUITE 101
City : HOLLYWOOD
State : FL
Zip : 33026-1505
Country : US
Telephone Number : 954-443-8010
Fax Number : 305-412-8265
Provider Business Practice Location Address
First Line : 11011 SHERIDAN ST
Second Line : SUITE 101
City : HOLLYWOOD
State : FL
Zip : 33026-1505
Country : US
Telephone Number : 954-443-8010
Fax Number : 305-412-8265
Authorized Official
Title or Position : PRESIDENT
Name : MR. STEPHEN E CIANCIULLI
Credential :
Telephone Number : 305-275-6069
Provider Enumeration Date : 03/12/2007
Last Update Date : 05/13/2008

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Directions to “PEMBROKE WEST DIAGNOSTIC IMAGING INC ” Practice Location

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