Provider Demographics
NPI:1730173089
Name:NEURO IMAGING INSTITUTE OF WINTER PARK, LTD
Entity type:Organization
Organization Name:NEURO IMAGING INSTITUTE OF WINTER PARK, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COLLECTIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:LENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-478-0859
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0550
Mailing Address - Country:US
Mailing Address - Phone:407-478-1550
Mailing Address - Fax:407-478-2495
Practice Address - Street 1:2111 GLENWOOD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3328
Practice Address - Country:US
Practice Address - Phone:407-478-1550
Practice Address - Fax:407-478-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7990Medicare ID - Type UnspecifiedPROVIDER NUMBER