Healthcare Provider Details

I. General information

NPI: 1417907023
Provider Name (Legal Business Name): VALLEY ADVANCED IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 BUTLER STREET
EASTON PA
18042
US

IV. Provider business mailing address

2403 BUTLER STREET
EASTON PA
18042
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-1200
  • Fax: 610-258-1106
Mailing address:
  • Phone: 610-258-1200
  • Fax: 610-258-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number3054015
License Number StatePA

VIII. Authorized Official

Name: MR. JAMES J STUPPINO
Title or Position: CEO OWNER
Credential:
Phone: 610-865-4738