Provider Demographics
NPI:1063461622
Name:AMAR N. GULATI, PC- RAYTEL MEDICAL IMAGING
Entity Type:Organization
Organization Name:AMAR N. GULATI, PC- RAYTEL MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLANEGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-831-1112
Mailing Address - Street 1:7 WATERSIDE XING
Mailing Address - Street 2:3RD FLOOR ATTN: KAREN FRISK, CONTRACTING
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1540
Mailing Address - Country:US
Mailing Address - Phone:800-367-1095
Mailing Address - Fax:860-298-6127
Practice Address - Street 1:430 PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2699
Practice Address - Country:US
Practice Address - Phone:610-831-0500
Practice Address - Fax:610-831-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011374950002Medicaid
PA035401Medicare PIN