=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770589277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRI RADIOLOGY NETWORK PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5051 S CONGRESS AVE
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-4704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-361-9191
-----------------------------------------------------
Fax | 561-394-5674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3848 FAU BLVD SUITE 200
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-362-9191
-----------------------------------------------------
Fax | 561-394-5674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT MEDICAL DIRECTOR
-----------------------------------------------------
Name | FRED STEINBERG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-362-9191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | ME56655
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------