Provider Demographics
NPI:1336289503
Name:ROCKLEDGE MRI AND PET CENTER LLC
Entity Type:Organization
Organization Name:ROCKLEDGE MRI AND PET CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NIAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-446-2023
Mailing Address - Street 1:1910 ROCKLEDGE BLVD
Mailing Address - Street 2:UNIT 102
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3723
Mailing Address - Country:US
Mailing Address - Phone:321-636-6599
Mailing Address - Fax:
Practice Address - Street 1:1910 ROCKLEDGE BLVD
Practice Address - Street 2:UNIT 102
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3723
Practice Address - Country:US
Practice Address - Phone:321-636-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography