Provider Demographics
NPI:1619113610
Name:TRI-STATE CARDIOVASCULAR IMAGING ASSOCIATES, INC.
Entity Type:Organization
Organization Name:TRI-STATE CARDIOVASCULAR IMAGING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TITAYEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-842-0870
Mailing Address - Street 1:3502 SCOTTS LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1561
Mailing Address - Country:US
Mailing Address - Phone:215-842-0870
Mailing Address - Fax:215-974-7466
Practice Address - Street 1:3502 SCOTTS LN
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1561
Practice Address - Country:US
Practice Address - Phone:215-842-0870
Practice Address - Fax:215-974-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-21
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471N0900X, 2471V0105X
PAPA-1134261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty