Organization
MYVY SOUTHWEST IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENNADIY VERLOKA (PRESIDENT)
(646) 932-4565
Entity
Organization
Contact information
Practice address
1160 KANE CONCOURSE STE 402, BAY HARBOR IS, FL 33154-2059
(646) 932-4565
Mailing address
1160 KANE CONCOURSE STE 402, BAY HARBOR IS, FL 33154-2059
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
11/16/2018
Last updated
12/03/2018
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