Provider Demographics
NPI:1043762792
Name:LIFECARE DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:LIFECARE DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FARIA
Authorized Official - Middle Name:SALEEM
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-470-2533
Mailing Address - Street 1:1117 ROUTE 46
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2449
Mailing Address - Country:US
Mailing Address - Phone:973-777-8100
Mailing Address - Fax:973-777-5108
Practice Address - Street 1:1117 ROUTE 46
Practice Address - Street 2:SUITE # 102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2449
Practice Address - Country:US
Practice Address - Phone:973-777-8100
Practice Address - Fax:973-777-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)