MEDICARE: HEALTH DIAGNOSTICS OF FORT LAUDERDALE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	HCC4707	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V2824	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518059781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH DIAGNOSTICS OF FORT LAUDERDALE LLC

Provider Business Mailing Address
First Line	:	PO BOX 170
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-0170
Country	:	US
Telephone Number	:	631-396-1050
Fax Number	:	631-390-1780

Provider Business Practice Location Address
First Line	:	4616 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5206
Country	:	US
Telephone Number	:	954-489-0099
Fax Number	:	954-489-0040

Authorized Official
Title or Position	:	MANAGER
Name	:	TIMOTHY DAMADIAN
Credential	:
Telephone Number	:	631-694-2816

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	05/12/2016

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