Provider Demographics
NPI:1871596015
Name:BEACHES OPEN MRI OF BOYNTON BEACH LLC
Entity type:Organization
Organization Name:BEACHES OPEN MRI OF BOYNTON BEACH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAJAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-732-3909
Mailing Address - Street 1:1700 W WOOLBRIGHT RD
Mailing Address - Street 2:STE 3
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6346
Mailing Address - Country:US
Mailing Address - Phone:561-732-3909
Mailing Address - Fax:561-732-2966
Practice Address - Street 1:1700 W WOOLBRIGHT RD
Practice Address - Street 2:STE 3
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6346
Practice Address - Country:US
Practice Address - Phone:561-732-3909
Practice Address - Fax:561-732-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264695100Medicaid
FLE6999Medicare ID - Type UnspecifiedPROVIDER #