Healthcare Provider Details

I. General information

NPI: 1598257412
Provider Name (Legal Business Name): TRISTATE TESLA IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 S DUPONT HWY
DOVER DE
19901-4404
US

IV. Provider business mailing address

PO BOX 47
MIDDLETOWN DE
19709-0047
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-3244
  • Fax:
Mailing address:
  • Phone: 302-696-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: JOHNNY RAMAZINI
Title or Position: OWNER
Credential:
Phone: 561-866-3244