Healthcare Provider Details

I. General information

NPI: 1578503165
Provider Name (Legal Business Name): PRESTIGE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 UNIVERSITY PKWY UNIVERSITY HEALTH PARK, BUILING 3, SUITE 112
SARASOTA FL
34243-2809
US

IV. Provider business mailing address

PO BOX 919028
ORLANDO FL
32891-9028
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-2130
  • Fax: 941-487-2138
Mailing address:
  • Phone: 727-793-9300
  • Fax: 727-793-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD JAY LICHTENSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 941-487-2550