Provider Demographics
NPI:1023002367
Name:MOBILE IMAGING LTD.
Entity Type:Organization
Organization Name:MOBILE IMAGING LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-437-1622
Mailing Address - Street 1:6400 COLLAMER RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1032
Mailing Address - Country:US
Mailing Address - Phone:315-437-1622
Mailing Address - Fax:315-437-3190
Practice Address - Street 1:7 HERBERT DRIVE
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3801
Practice Address - Country:US
Practice Address - Phone:518-785-3511
Practice Address - Fax:518-783-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01867427Medicaid
NY01738554Medicaid
NY01867427Medicaid
NYBB6154Medicare PIN
NYBB6154Medicare PIN