MEDICARE: MOBILE DIAGNOSTIC X-RAY, INC.

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	:	1831150606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE DIAGNOSTIC X-RAY, INC.

Provider Business Mailing Address
First Line	:	1091 BAYVIEW AVE
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-3130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1091 BAYVIEW AVE
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-3130
Country	:	US
Telephone Number	:	732-269-4343
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACK BARKER
Credential	:
Telephone Number	:	732-269-4343

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	02/04/2010

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