Provider Demographics
NPI:1073669545
Name:ALPHA SCAN IMAGING, LLC
Entity Type:Organization
Organization Name:ALPHA SCAN IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAOUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-794-0053
Mailing Address - Street 1:60 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2039
Mailing Address - Country:US
Mailing Address - Phone:973-794-0053
Mailing Address - Fax:973-866-0353
Practice Address - Street 1:545 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2971
Practice Address - Country:US
Practice Address - Phone:201-689-2111
Practice Address - Fax:201-689-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089752Medicare PIN