Organization
ICON IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAUSTO L MINAYA (OWNER)
(203) 553-9696
Entity
Organization
Contact information
Practice address
540 BISHOP DR, ORANGE, CT 06477-2522
(203) 553-9696
Mailing address
PO BOX 566, ORANGE, CT 06477-0566
(203) 553-9696
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
10/31/2016
Last updated
10/31/2016
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