Organization
PRESTIGE IMAGING LLC
Active
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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