Healthcare Provider Details
I. General information
NPI: 1942344262
Provider Name (Legal Business Name): ON-SITE IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/19/2007
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
50 US HWY 9 NORTH, SUITE 102 GROSSO OFFICE PARK
MORGANVILLE NJ
07751
US
IV. Provider business mailing address
50 HIGHWAY 9 SUITE 102 GROSSO OFFICE PARK
MORGANVILLE NJ
07751-3321
US
V. Phone/Fax
- Phone: 732-718-3906
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261Q00000X |
| Taxonomy | Clinic/Center |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 335V00000X |
| Taxonomy | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ANNA
BAKSHIYEVA
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-580-0660