Provider Demographics
NPI:1134315955
Name:SYNAPSE RADIOLOGY ASSOCIATE, P.A.
Entity Type:Organization
Organization Name:SYNAPSE RADIOLOGY ASSOCIATE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:IWASKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-369-8557
Mailing Address - Street 1:1200 CHANCELLOR LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-9097
Mailing Address - Country:US
Mailing Address - Phone:972-369-8557
Mailing Address - Fax:972-542-6915
Practice Address - Street 1:1200 CHANCELLOR LN
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-9097
Practice Address - Country:US
Practice Address - Phone:972-369-8557
Practice Address - Fax:972-542-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-16
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL33472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty