Provider Demographics
NPI:1033367743
Name:MOBILE CV IMAGING, LLC
Entity Type:Organization
Organization Name:MOBILE CV IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYBIL
Authorized Official - Middle Name:GAUTHIER
Authorized Official - Last Name:MALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-331-7597
Mailing Address - Street 1:136 GROVERS AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3536
Mailing Address - Country:US
Mailing Address - Phone:203-767-3332
Mailing Address - Fax:203-612-8391
Practice Address - Street 1:136 GROVERS AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-3536
Practice Address - Country:US
Practice Address - Phone:203-767-3332
Practice Address - Fax:203-612-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033357207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty