Provider Demographics
NPI:1326089038
Name:ROENTGEN DIAGNOSTIC
Entity Type:Organization
Organization Name:ROENTGEN DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERMENEGILDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ABIN
Authorized Official - Suffix:
Authorized Official - Credentials:RTR
Authorized Official - Phone:305-461-3777
Mailing Address - Street 1:13591 SW 135TH AVE
Mailing Address - Street 2:UNIT 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5841
Mailing Address - Country:US
Mailing Address - Phone:305-461-3777
Mailing Address - Fax:305-529-9333
Practice Address - Street 1:13591 SW 135TH AVE
Practice Address - Street 2:UNIT 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5841
Practice Address - Country:US
Practice Address - Phone:305-461-3777
Practice Address - Fax:305-529-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLW9945Medicare ID - Type Unspecified