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General NPI Number Information
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NPI Number | 1174043202
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Entity Type | Organization
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Legal Business Name | JUPITER IMAGING ASSOCIATES, INC
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 725 RANTOUL LN
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City | LAKE MARY
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State | FL
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Zip | 32746-4249
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Country | US
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Telephone | 954-838-2371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3147
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3147
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Country | US
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Telephone | 954-838-2371
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | GILBERT DROZDOW
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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