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General NPI Number Information
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NPI Number | 1043431349
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Entity Type | Organization
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Legal Business Name | CENTERLIGHT DIAGNOSTIC AND TREATMENT CENTER, INC.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 1250 WATERS PL TOWER 1 SUITE 602
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City | BRONX
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State | NY
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Zip | 10461-2720
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Country | US
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Telephone | 347-640-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 WATERS PL TOWER 1 SUITE 602
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City | BRONX
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State | NY
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Zip | 10461-2720
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Country | US
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Telephone | 347-640-6050
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Fax |
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | MR. RICHARD ROSEN
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Credential |
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Telephone | 347-640-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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