MEDICARE: IMEDICAL DIAGNOSTIC IMAGING CENTER OF NAPLES, 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	HCC8783	FL

General Provider Information

NPI Number	:	1871806133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMEDICAL DIAGNOSTIC IMAGING CENTER OF NAPLES, LLC

Provider Business Mailing Address
First Line	:	1350 TAMIAMI TRAIL NORTH
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5209
Country	:	US
Telephone Number	:	239-430-4674
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 WEST MAIN STREET
Second Line	:	SUITE 108
City	:	BABYLON
State	:	NY
Zip	:	11702-3028
Country	:	US
Telephone Number	:	631-240-2277
Fax Number	:	631-517-8007

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	MR. ALAN STERNBERG
Credential	:
Telephone Number	:	239-430-4674

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	07/15/2010

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