MEDICARE: SKY MOBILE DIGITAL IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1699217539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY MOBILE DIGITAL IMAGING LLC

Provider Business Mailing Address
First Line	:	194 DAFFODIL DR
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-9355
Country	:	US
Telephone Number	:	732-839-9010
Fax Number	:	732-839-9012

Provider Business Practice Location Address
First Line	:	2 KENNEDY BLVD
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1248
Country	:	US
Telephone Number	:	732-839-9012
Fax Number	:	732-839-9012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER GUDAITIS
Credential	:
Telephone Number	:	732-245-5123

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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