Provider Demographics
NPI:1003129198
Name:WINTERGREEN IMAGING AND DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:WINTERGREEN IMAGING AND DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIPNACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-581-0348
Mailing Address - Street 1:1112 RIVERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2964
Mailing Address - Country:US
Mailing Address - Phone:610-581-0348
Mailing Address - Fax:610-581-0349
Practice Address - Street 1:1112 RIVERVIEW LN
Practice Address - Street 2:
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2964
Practice Address - Country:US
Practice Address - Phone:610-581-0348
Practice Address - Fax:610-581-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty