Healthcare Provider Details

I. General information

NPI: 1972424471
Provider Name (Legal Business Name): IMPRESSION IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S FLAMINGO RD STE 8
PEMBROKE PINES FL
33027-1770
US

IV. Provider business mailing address

330 S FLAMINGO RD STE 8
PEMBROKE PINES FL
33027-1770
US

V. Phone/Fax

Practice location:
  • Phone: 954-580-2780
  • Fax: 954-580-2780
Mailing address:
  • Phone:
  • Fax:

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: MICHAEL FAGIEN
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 954-580-2780