Provider Demographics
NPI:1346414414
Name:ARISTA IMAGING OF FORT MYERS LLC
Entity Type:Organization
Organization Name:ARISTA IMAGING OF FORT MYERS LLC
Other - Org Name:ARISTA MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-913-7000
Mailing Address - Street 1:700A KOEHLER AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7406
Mailing Address - Country:US
Mailing Address - Phone:631-913-7000
Mailing Address - Fax:631-580-5070
Practice Address - Street 1:12995 S CLEVELAND AVE
Practice Address - Street 2:SUITE 182
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3890
Practice Address - Country:US
Practice Address - Phone:239-936-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)