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General NPI Number Information
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NPI Number | 1821161811
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Entity Type | Organization
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Legal Business Name | ROCKVILLE PET IMAGING PC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 119 N PARK AVE SUITE 101
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4113
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Country | US
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Telephone | 516-255-9555
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Fax | 516-255-9444
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Provider Business Mailing Address
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Address Line | 119 N PARK AVE SUITE 101
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4113
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Country | US
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Telephone | 516-255-9555
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Fax | 516-255-9444
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MRS. LUCILLE PATRICIA TAVERNA
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Credential | M.D.
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Telephone | 516-255-9555
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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 | 1124741
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License Number State | NY
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