Provider Demographics
NPI:1679800726
Name:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING, INC.
Entity type:Organization
Organization Name:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-482-5253
Mailing Address - Street 1:1150 S SEMORAN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1424
Mailing Address - Country:US
Mailing Address - Phone:407-482-5253
Mailing Address - Fax:407-482-5254
Practice Address - Street 1:8903 GLADES RD
Practice Address - Street 2:SUITE B1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4074
Practice Address - Country:US
Practice Address - Phone:561-218-9011
Practice Address - Fax:561-218-9012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTAMONTE SPRINGS DIAGNOSTIC IMAGING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-11
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty