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General NPI Number Information
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NPI Number | 1700894755
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Entity Type | Organization
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Legal Business Name | ADVANCED BREAST CARE IMAGING LLC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 250 CETRONIA ROAD SUITE 102
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City | ALLENTOWN
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State | PA
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Zip | 18104
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Country | US
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Telephone | 610-366-0444
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Fax | 610-366-7288
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Provider Business Mailing Address
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Address Line | 250 CETRONIA RD SUITE 102
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City | ALLENTOWN
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State | PA
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Zip | 18104-9147
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Country | US
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Telephone | 610-366-0444
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Fax | 610-366-7288
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MARK ALAN GITTLEMAN
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Credential | MD
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Telephone | 610-366-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 3331356
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License Number State | PA
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