Provider Demographics
NPI:1528714714
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:954-580-2780
Mailing Address - Fax:
Practice Address - Street 1:6853 SW 18TH ST STE M101
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7056
Practice Address - Country:US
Practice Address - Phone:561-473-4610
Practice Address - Fax:954-580-2790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMPRESSION IMAGING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty