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General NPI Number Information
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NPI Number | 1841596897
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Entity Type | Organization
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Legal Business Name | ULTRASOUND IMAGE CENTER LLC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 2351 E ALLEGHENY AVE SUITE 1
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City | PHILA
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State | PA
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Zip | 19134-4431
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Country | US
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Telephone | 215-427-0324
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Fax | 215-427-0308
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Provider Business Mailing Address
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Address Line | 2351 E ALLEGHENY AVE SUITE 1
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City | PHILA
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State | PA
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Zip | 19134-4431
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Country | US
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Telephone | 215-427-0324
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Fax | 215-427-0308
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. STEPHANIE MAZZAGATTI
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Credential |
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Telephone | 215-427-0324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 37657
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License Number State | PA
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