1750315081 NPI number — RADIOLOGY ASSOCIATES OF LAKE CITY PA

Table of content: DR. YAEL CHATAV SCHONBRUN PH.D. (NPI 1073817037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750315081 NPI number — RADIOLOGY ASSOCIATES OF LAKE CITY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES OF LAKE CITY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750315081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 691
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32056-0691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-752-9144
Provider Business Mailing Address Fax Number:
386-752-5881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
183 NW GWEN LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32055-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-752-9144
Provider Business Practice Location Address Fax Number:
386-752-5881
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEDOYA-GARCIA
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
386-752-9144

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com