Provider Demographics
NPI:1013186014
Name:NORTHEAST IMAGING & DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:NORTHEAST IMAGING & DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-942-2440
Mailing Address - Street 1:472 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2565
Mailing Address - Country:US
Mailing Address - Phone:973-942-2440
Mailing Address - Fax:973-942-3367
Practice Address - Street 1:472 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2565
Practice Address - Country:US
Practice Address - Phone:973-942-2440
Practice Address - Fax:973-942-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center