Healthcare Provider Details

I. General information

NPI: 1659441236
Provider Name (Legal Business Name): DIAGNOSTIC RADIOLOGY CENTER OF THE TREASURE COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 SOUTH 25TH ST SUITE 106
FT PIERCE FL
34947
US

IV. Provider business mailing address

2011 SOUTH 25TH ST SUITE 106
FT PIERCE FL
34947
US

V. Phone/Fax

Practice location:
  • Phone: 772-468-7020
  • Fax: 772-468-7698
Mailing address:
  • Phone: 772-468-7020
  • Fax: 772-468-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AJAY KUMAR GOYAL
Title or Position: PRESIDENT MD
Credential: MD
Phone: 772-468-7020