Healthcare Provider Details

I. General information

NPI: 1538196464
Provider Name (Legal Business Name): RELIABLE RADIOGRAPHICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4377 ROCK ISLAND RD
LAUDERHILL FL
33319-4520
US

IV. Provider business mailing address

4377 ROCK ISLAND RD
LAUDERHILL FL
33319-4520
US

V. Phone/Fax

Practice location:
  • Phone: 954-733-5008
  • Fax: 954-731-5222
Mailing address:
  • Phone: 954-733-5008
  • Fax: 954-731-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number5605
License Number StateFL

VIII. Authorized Official

Name: ISIDORE ANTONOFF
Title or Position: PRESIDENT
Credential:
Phone: 954-733-5008