Healthcare Provider Details

I. General information

NPI: 1467448431
Provider Name (Legal Business Name): CARDIO NUCLEAR DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 CORAL GATE BLVD
MARGATE FL
33063-1531
US

IV. Provider business mailing address

4519 GEORGE RD STE. 100
TAMPA FL
33634-7329
US

V. Phone/Fax

Practice location:
  • Phone: 954-969-1315
  • Fax:
Mailing address:
  • Phone: 813-496-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberME19375
License Number StateFL

VIII. Authorized Official

Name: NORMAN HENRY PEVSNER
Title or Position: OWNER
Credential: M.D.
Phone: 954-969-1315