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General NPI Number Information
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NPI Number | 1326395989
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Entity Type | Organization
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Legal Business Name | MEET UR BABY 3D @ MADELINE'S PLACE, LLC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 808 SEVEN BRIDGE RD
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City | E STROUDSBURG
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State | PA
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Zip | 18301-7942
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Country | US
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Telephone | 570-369-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 808 SEVEN BRIDGE RD
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City | E STROUDSBURG
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State | PA
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Zip | 18301-7942
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Country | US
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Telephone | 570-369-8888
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. MAIRA SANTIAGO
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Credential | RDMS
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Telephone | 570-369-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 71843
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License Number State | NJ
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