Healthcare Provider Details

I. General information

NPI: 1730218488
Provider Name (Legal Business Name): GALLOWAY DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 SW 87TH AVE SUITE 220
MIAMI FL
33173-5458
US

IV. Provider business mailing address

7400 SW 87TH AVE SUITE 220
MIAMI FL
33173-5458
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-4425
  • Fax: 305-412-8265
Mailing address:
  • Phone: 305-595-4425
  • Fax: 305-412-8265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN E CIANCIULLI
Title or Position: PRESIDENT
Credential:
Phone: 305-275-6069