Healthcare Provider Details

I. General information

NPI: 1396779237
Provider Name (Legal Business Name): ADVANCED MOBILE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW HAVEN AVE
MILFORD CT
06460-4854
US

IV. Provider business mailing address

PO BOX 416
MILFORD CT
06460-0416
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-6768
  • Fax: 203-878-6087
Mailing address:
  • Phone: 203-878-6768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number003259
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number003259
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number81408
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number003259
License Number StateCT

VIII. Authorized Official

Name: MR. BRIAN F ELZIN
Title or Position: MANAGING MEMBER
Credential: B.S., RDMS, RT (R)
Phone: 203-878-6768