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Organization
LAKE WORTH DIAGNOSTIC TESTING GROUP INC
Active
Organization
LAKE WORTH DIAGNOSTIC TESTING GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN E CIANCIULLI (PRESIDENT)
(305) 275-6069
Entity
Organization
Contact information
Practice address
3713 S CONGRESS AVE, LAKE WORTH, FL 33461-3753
(561) 964-8414
(305) 412-8265
Mailing address
3713 S CONGRESS AVE, LAKE WORTH, FL 33461-3753
(561) 964-8414
(305) 412-8265
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
03/08/2007
Last updated
05/13/2008
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