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General NPI Number Information
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NPI Number | 1215990833
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Entity Type | Organization
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Legal Business Name | DELRAY EFL IMAGING CENTER LLC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 4800 LINTON BLVD BUILDING C
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6584
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Country | US
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Telephone | 561-638-2499
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 LINTON BLVD BUILDING C
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6584
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Country | US
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Telephone | 561-638-2499
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Fax |
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Authorized Official
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Title or Position | VP IMAGING SERVICES
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Name | WANDAY FOGARTY
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Credential |
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Telephone | 561-838-3630
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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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