Provider Demographics
NPI:1871559716
Name:PET CT IMAGING CENTER LLC
Entity type:Organization
Organization Name:PET CT IMAGING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANWER
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTHAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-763-8001
Mailing Address - Street 1:2555 PONCE DE LEON BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-702-5135
Mailing Address - Fax:305-441-2144
Practice Address - Street 1:30 HARRISON STREET
Practice Address - Street 2:STE 102
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-729-7082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1474Medicare PIN