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General NPI Number Information
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NPI Number | 1528714714
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Entity Type | Organization
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Legal Business Name | IMPRESSION IMAGING LLC
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 6853 SW 18TH ST STE M101
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City | BOCA RATON
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State | FL
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Zip | 33433-7056
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Country | US
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Telephone | 561-473-4610
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Fax | 954-580-2790
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Provider Business Mailing Address
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Address Line | PO BOX 21422
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City | NEW YORK
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State | NY
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Zip | 10087-1422
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Country | US
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Telephone | 954-580-2780
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MICHAEL FAGIEN
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Credential | MD
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Telephone | 954-580-2780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear 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 | 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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