Provider Demographics
NPI:1104637537
Name:IMPRESSION IMAGING LLC
Entity type:Organization
Organization Name:IMPRESSION IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-580-2780
Mailing Address - Street 1:PO BOX 21422
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-1422
Mailing Address - Country:US
Mailing Address - Phone:347-577-9062
Mailing Address - Fax:
Practice Address - Street 1:3111 N UNIVERSITY DR STE 115
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5049
Practice Address - Country:US
Practice Address - Phone:954-580-2780
Practice Address - Fax:954-580-2790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPRESSION IMAGING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty