Healthcare Provider Details

I. General information

NPI: 1780633594
Provider Name (Legal Business Name): RAYTEL MEDICAL IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUTE 168 SUITE G
TURNERSVILLE NJ
08012-3233
US

IV. Provider business mailing address

PO BOX 548
WINDSOR CT
06095-0548
US

V. Phone/Fax

Practice location:
  • Phone: 856-232-7474
  • Fax: 856-232-3834
Mailing address:
  • Phone: 800-367-1095
  • Fax: 860-298-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number22390
License Number StateNJ

VIII. Authorized Official

Name: MR. JEFFREY M FLANEGIN
Title or Position: PRESIDENT
Credential:
Phone: 610-831-1112