Provider Demographics
NPI:1518059781
Name:HEALTH DIAGNOSTICS OF FORT LAUDERDALE LLC
Entity Type:Organization
Organization Name:HEALTH DIAGNOSTICS OF FORT LAUDERDALE LLC
Other - Org Name:STAND-UP MRI OF FORT LAUDERDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-694-2816
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-0170
Mailing Address - Country:US
Mailing Address - Phone:631-396-1050
Mailing Address - Fax:631-390-1780
Practice Address - Street 1:4616 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5206
Practice Address - Country:US
Practice Address - Phone:954-489-0099
Practice Address - Fax:954-489-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
FLHCC4707261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2824OtherBCBS
FL40405Medicare PIN