Basic Information
| Provider Information | |||||||||
| NPI: | 1467781120 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMAGING & RADIOLOGY SPECIALISTS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2655 STATE ROAD 580 STE 202 | ||||||||
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| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337613167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274991041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1395 S PINELLAS AVE | ||||||||
| Address2: | |||||||||
| City: | TARPON SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346893790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279425000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2009 | ||||||||
| LastUpdateDate: | 12/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | NIEDZWIECKI | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7277917300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.