Provider Demographics
NPI:1386034668
Name:ADVANCED METROPOLITAN RADIOLOGY LLC
Entity type:Organization
Organization Name:ADVANCED METROPOLITAN RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TOBON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-519-1479
Mailing Address - Street 1:9425 WORSWICK CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6423
Mailing Address - Country:US
Mailing Address - Phone:646-519-1479
Mailing Address - Fax:
Practice Address - Street 1:9425 WORSWICK CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6423
Practice Address - Country:US
Practice Address - Phone:646-519-1479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty