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General NPI Number Information
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NPI Number | 1508231465
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Entity Type | Organization
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Legal Business Name | DIGITAL IMAGING CENTER, P.A.
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 180 N DEAN ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2534
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Country | US
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Telephone | 201-568-4243
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Fax |
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Provider Business Mailing Address
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Address Line | 180 N DEAN ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2534
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Country | US
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Telephone | 201-568-4243
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CHRISTOPHER L PETTI
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Credential | M.D.
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Telephone | 201-568-4243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA07059300
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License Number State | NJ
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