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General NPI Number Information
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NPI Number | 1619113610
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Entity Type | Organization
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Legal Business Name | TRI-STATE CARDIOVASCULAR IMAGING ASSOCIATES, INC.
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Dates
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Enumeration Date | 12/21/2008
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Last Update Date | 12/21/2008
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Provider Practice Location Address
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Address Line | 3502 SCOTTS LN SUITE 2
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1561
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Country | US
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Telephone | 215-842-0870
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Fax | 215-974-7466
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Provider Business Mailing Address
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Address Line | 3502 SCOTTS LN SUITE 2
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1561
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Country | US
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Telephone | 215-842-0870
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Fax | 215-974-7466
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL TITAYEVSKY
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Credential |
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Telephone | 215-842-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471N0900X
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Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
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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 | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | PA-1134
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License Number State | PA
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