Healthcare Provider Details

I. General information

NPI: 1730118910
Provider Name (Legal Business Name): BIOPATH RAD HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 N ONTARIO ST
BURBANK CA
91504-2015
US

IV. Provider business mailing address

101 N 3RD ST
BROOKLYN NY
11211-3943
US

V. Phone/Fax

Practice location:
  • Phone: 718-594-1001
  • Fax:
Mailing address:
  • Phone: 718-594-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number87208
License Number StateCA

VIII. Authorized Official

Name: MR. AARON WEXLER
Title or Position: MEMBER
Credential:
Phone: 818-480-9100