Provider Demographics
NPI:1659441236
Name:DIAGNOSTIC RADIOLOGY CENTER OF THE TREASURE COAST
Entity Type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY CENTER OF THE TREASURE COAST
Other - Org Name:AJAY K GOYAL MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT MD
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-468-7020
Mailing Address - Street 1:2011 SOUTH 25TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947
Mailing Address - Country:US
Mailing Address - Phone:772-468-7020
Mailing Address - Fax:772-468-7698
Practice Address - Street 1:2011 SOUTH 25TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947
Practice Address - Country:US
Practice Address - Phone:772-468-7020
Practice Address - Fax:772-468-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G66233Medicare UPIN
K7017Medicare ID - Type Unspecified