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General NPI Number Information
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NPI Number | 1972007334
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Entity Type | Organization
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Legal Business Name | TRITON IMAGING, LLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 119 IVY LN
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City | TENAFLY
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State | NJ
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Zip | 07670-2410
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Country | US
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Telephone | 917-399-3596
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Fax |
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Provider Business Mailing Address
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Address Line | 119 IVY LN
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City | TENAFLY
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State | NJ
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Zip | 07670-2410
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Country | US
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Telephone | 917-399-3596
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN B STARK
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Credential |
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Telephone | 917-399-3596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State | NJ
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