Healthcare Provider Details

I. General information

NPI: 1174588172
Provider Name (Legal Business Name): PENNSVILLE MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 S BROADWAY
PENNSVILLE NJ
08070-2724
US

IV. Provider business mailing address

248 S BROADWAY
PENNSVILLE NJ
08070-2724
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-4224
  • Fax: 856-678-9435
Mailing address:
  • Phone: 856-678-4224
  • Fax: 856-678-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARSHID TAATI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 856-678-4224