Healthcare Provider Details

I. General information

NPI: 1427679836
Provider Name (Legal Business Name): HEALTH DIAGNOSTICS OF FORT LAUDERDALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16604 SHERIDAN STREET
PEMBROKE PINES FL
33331
US

IV. Provider business mailing address

PO BOX 170
FARMINGDALE NY
11735-0170
US

V. Phone/Fax

Practice location:
  • Phone: 954-688-4040
  • Fax: 954-688-4050
Mailing address:
  • Phone: 631-694-2816
  • Fax: 631-390-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KURT W REIMANN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 631-694-2816