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General NPI Number Information
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NPI Number | 1801618053
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Entity Type | Organization
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Legal Business Name | NORTHERN LIGHT RADIOLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1895 TYLER ST STE 207
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4828
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Country | US
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Telephone | 747-202-9238
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Fax |
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Provider Business Mailing Address
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Address Line | 1895 TYLER ST STE 207
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4828
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Country | US
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Telephone | 747-202-9238
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PATRICK SANTORE JR.
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Credential |
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Telephone | 813-924-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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