Healthcare Provider Details

I. General information

NPI: 1902142151
Provider Name (Legal Business Name): CARISK IMAGING IPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25A HANOVER RD STE 201
FLORHAM PARK NJ
07932-1407
US

IV. Provider business mailing address

25A HANOVER RD STE 201
FLORHAM PARK NJ
07932-1407
US

V. Phone/Fax

Practice location:
  • Phone: 973-451-9415
  • Fax: 973-451-9541
Mailing address:
  • Phone: 973-451-9415
  • Fax: 973-451-9541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN M MAHONEY
Title or Position: PRESIDENT
Credential:
Phone: 770-865-3222