Provider Demographics
NPI:1053685511
Name:PROFESSIONAL MOBILE DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:PROFESSIONAL MOBILE DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-661-7512
Mailing Address - Street 1:3709 WELLS DR
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1321
Mailing Address - Country:US
Mailing Address - Phone:732-661-7512
Mailing Address - Fax:
Practice Address - Street 1:1810 KENNEDY BOULEVARD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305
Practice Address - Country:US
Practice Address - Phone:732-661-7512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile