Provider Demographics
NPI:1346645033
Name:ICONIC IMAGING, INC.
Entity Type:Organization
Organization Name:ICONIC IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAGI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-773-9598
Mailing Address - Street 1:815 SE 1ST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7102
Mailing Address - Country:US
Mailing Address - Phone:954-773-9598
Mailing Address - Fax:954-773-9588
Practice Address - Street 1:150 SW 12TH AVE STE 101B
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-773-9598
Practice Address - Fax:954-773-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology