Healthcare Provider Details

I. General information

NPI: 1881604940
Provider Name (Legal Business Name): TOLL GATE RADIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD STE 101A, STE 102
WARWICK RI
02886-4416
US

IV. Provider business mailing address

215 TOLL GATE RD STE 109
WARWICK RI
02886-4458
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-3100
  • Fax: 401-738-8505
Mailing address:
  • Phone: 401-738-3100
  • Fax: 401-738-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberRAD0066
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberRAD0066
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberRAD0066
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberRAD0066
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberRAD0066
License Number StateRI
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberRAD0066
License Number StateRI
# 7
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberRAD0066
License Number StateRI
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberRAD0066
License Number StateRI

VIII. Authorized Official

Name: DR. ANTHONY G BRUZZESE
Title or Position: PRESIDENT
Credential: MD
Phone: 401-738-3100