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General NPI Number Information
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NPI Number | 1083891667
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Entity Type | Organization
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Legal Business Name | LONG BEACH IMAGING CENTER LLC
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Dates
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Enumeration Date | 01/26/2008
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Last Update Date | 01/26/2008
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Provider Practice Location Address
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Address Line | 120 W PARK AVE SUITE 306
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City | LONG BEACH
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State | NY
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Zip | 11561-3301
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Country | US
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Telephone | 516-431-0727
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W PARK AVE SUITE 306
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City | LONG BEACH
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State | NY
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Zip | 11561-3301
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Country | US
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Telephone | 516-431-0727
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GLEN SHANOCK
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Credential | DDS
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Telephone | 516-431-0727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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