Provider Demographics
NPI:1013260348
Name:LEVITTOWN IMAGING CENTER INC.
Entity Type:Organization
Organization Name:LEVITTOWN IMAGING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-795-2055
Mailing Address - Street 1:PO BOX 50413
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0413
Mailing Address - Country:US
Mailing Address - Phone:787-795-2055
Mailing Address - Fax:787-261-6461
Practice Address - Street 1:1173 DOS PALMAS AVE
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00950
Practice Address - Country:US
Practice Address - Phone:787-795-2055
Practice Address - Fax:787-261-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR84-024261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology