Provider Demographics
NPI:1932319852
Name:CHILDREN'S DIAGNOSTIC TESTING GROUP OF MIAMI, INC.
Entity Type:Organization
Organization Name:CHILDREN'S DIAGNOSTIC TESTING GROUP OF MIAMI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CIANCIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-275-6069
Mailing Address - Street 1:9485 SW 72ND ST
Mailing Address - Street 2:SUITE A150
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3242
Mailing Address - Country:US
Mailing Address - Phone:305-275-6069
Mailing Address - Fax:305-412-8265
Practice Address - Street 1:7400 SW 87TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5458
Practice Address - Country:US
Practice Address - Phone:305-275-6069
Practice Address - Fax:305-412-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology