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General NPI Number Information
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NPI Number | 1346645033
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Entity Type | Organization
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Legal Business Name | ICONIC IMAGING, INC.
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 150 SW 12TH AVE STE 101B
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City | POMPANO BEACH
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State | FL
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Zip | 33069-3298
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Country | US
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Telephone | 954-773-9598
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Fax | 954-773-9588
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Provider Business Mailing Address
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Address Line | 815 SE 1ST AVE STE B
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-7102
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Country | US
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Telephone | 954-773-9598
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Fax | 954-773-9588
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SAGI SHAKED
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Credential |
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Telephone | 954-773-9598
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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 |
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License Number State | FL
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