Provider Demographics
NPI:1033505532
Name:GALAXY MOBILE DIAGNOSTICS SERVICES LLC
Entity Type:Organization
Organization Name:GALAXY MOBILE DIAGNOSTICS SERVICES LLC
Other - Org Name:IMAGEDX, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-789-1818
Mailing Address - Street 1:2 KENNEDY BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1248
Mailing Address - Country:US
Mailing Address - Phone:201-426-0220
Mailing Address - Fax:732-839-9012
Practice Address - Street 1:2 KENNEDY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1248
Practice Address - Country:US
Practice Address - Phone:201-426-0220
Practice Address - Fax:732-839-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0427055Medicaid
NJ370101Medicare PIN