Healthcare Provider Details

I. General information

NPI: 1205075322
Provider Name (Legal Business Name): FRANCES SHELLEY ARDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 TRICENTENNIAL DR
FREEHOLD NJ
07728-5328
US

IV. Provider business mailing address

61 TRICENTENNIAL DR
FREEHOLD NJ
07728-5328
US

V. Phone/Fax

Practice location:
  • Phone: 914-588-2788
  • Fax:
Mailing address:
  • Phone: 914-588-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number106988
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number106988
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: