Provider Demographics
NPI:1396992830
Name:EMRAN PARVEEN AND SON'S BREAST CENTER, LLC
Entity type:Organization
Organization Name:EMRAN PARVEEN AND SON'S BREAST CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMRAN
Authorized Official - Middle Name:RIAZ
Authorized Official - Last Name:IMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-733-1901
Mailing Address - Street 1:PO BOX 33428
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-0428
Mailing Address - Country:US
Mailing Address - Phone:321-733-1901
Mailing Address - Fax:321-733-0211
Practice Address - Street 1:1140 BROADBAND DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2623
Practice Address - Country:US
Practice Address - Phone:321-733-1901
Practice Address - Fax:321-733-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Multi-Specialty