Healthcare Provider Details

I. General information

NPI: 1740825074
Provider Name (Legal Business Name): INTEGRATED VASCULAR RADIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 GLADES RD STE 100
BOCA RATON FL
33434-4150
US

IV. Provider business mailing address

7777 GLADES RD STE 100
BOCA RATON FL
33434-4150
US

V. Phone/Fax

Practice location:
  • Phone: 404-789-4599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY GERSTEL
Title or Position: MBR
Credential: MD
Phone: 404-789-4599