Organization
PRESTIGE IMAGING LLC
Active
Other names
Prestige Imaging at University Groves
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD JAY LICHTENSTEIN MD (PRESIDENT)
(941) 487-2550
Entity
Organization
Contact information
Practice address
2415 UNIVERSITY PKWY, UNIVERSITY HEALTH PARK, BUILING 3, SUITE 112, SARASOTA, FL 34243-2809
(941) 487-2130
(941) 487-2138
Mailing address
PO BOX 919028, ORLANDO, FL 32891-9028
(727) 793-9300
(727) 793-0052
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273488500
—
FL
01
—
DE3457
RR MEDICARE
FL
01
—
V3087
BCBS
FL
Enumeration date
06/08/2006
Last updated
03/05/2009
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