Provider Demographics
NPI:1346746179
Name:DIVERSITY MRI LLC
Entity Type:Organization
Organization Name:DIVERSITY MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-347-2242
Mailing Address - Street 1:801 S UNIVERSITY DR STE K103A
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3367
Mailing Address - Country:US
Mailing Address - Phone:954-905-7217
Mailing Address - Fax:954-905-7218
Practice Address - Street 1:801 S UNIVERSITY DR STE K103A
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3367
Practice Address - Country:US
Practice Address - Phone:954-905-7217
Practice Address - Fax:954-905-7217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL17000172498261Q00000X, 261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center