=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285760041
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOBILE DIAGNOSTIC TESTING SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 08/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 SHEFFIELD ST SUITE 5C
-----------------------------------------------------
City | MOUNTAINSIDE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07092-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-518-0150
-----------------------------------------------------
Fax | 718-886-5762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4950 GENESEE ST SUITE 180
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14225-5550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-686-7100
-----------------------------------------------------
Fax | 716-614-3282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALAN ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-614-3285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------