Healthcare Provider Details

I. General information

NPI: 1508497413
Provider Name (Legal Business Name): NEW ENGLAND MOLECULAR IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 11/02/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OLD FREMONT RD
RAYMOND NH
03077
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 603-537-1363
  • Fax:
Mailing address:
  • Phone: 949-242-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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