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General NPI Number Information
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NPI Number | 1295487593
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Entity Type | Organization
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Legal Business Name | CONCIERGE RADIOLOGY GROUP LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 520 WEST AVE APT 705
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City | MIAMI BEACH
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State | FL
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Zip | 33139-6797
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Country | US
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Telephone | 516-509-3755
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Fax |
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Provider Business Mailing Address
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Address Line | 520 WEST AVE APT 705
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City | MIAMI BEACH
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State | FL
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Zip | 33139-6797
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Country | US
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Telephone | 516-509-3755
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | GUSTAVO PANTOL
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Credential |
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Telephone | 516-509-3755
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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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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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