Healthcare Provider Details

I. General information

NPI: 1275569782
Provider Name (Legal Business Name): NEW ENGLAND MOLECULAR IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TSIENNETO RD
DERRY NH
03038
US

IV. Provider business mailing address

18201 VON KARMAN AVE STE 600
IRVINE CA
92612-1176
US

V. Phone/Fax

Practice location:
  • Phone: 603-537-1380
  • Fax:
Mailing address:
  • Phone: 800-544-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number01601
License Number StateNH

VIII. Authorized Official

Name: LAURA KASSA
Title or Position: SR VP
Credential:
Phone: 904-300-2777