Healthcare Provider Details

I. General information

NPI: 1770589277
Provider Name (Legal Business Name): MRI RADIOLOGY NETWORK PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 S CONGRESS AVE
LAKE WORTH FL
33461-4704
US

IV. Provider business mailing address

3848 FAU BLVD SUITE 200
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 561-361-9191
  • Fax: 561-394-5674
Mailing address:
  • Phone: 561-362-9191
  • Fax: 561-394-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberME56655
License Number StateFL

VIII. Authorized Official

Name: FRED STEINBERG
Title or Position: PRESIDENT MEDICAL DIRECTOR
Credential: MD
Phone: 561-362-9191