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General NPI Number Information
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NPI Number | 1649418906
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Entity Type | Organization
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Legal Business Name | ADVANCED MOBILE IMAGING LLC
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Dates
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Enumeration Date | 01/25/2009
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 15 STELLING AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-2124
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Country | US
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Telephone | 201-338-0264
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Fax | 866-205-1988
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Provider Business Mailing Address
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Address Line | 15 STELLING AVE
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City | MAYWOOD
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State | NJ
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Zip | 07607-2124
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Country | US
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Telephone | 201-338-0264
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Fax | 866-205-1988
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. BRION ESULTO
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Credential | R.T.
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Telephone | 201-338-0264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State | NJ
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