Provider Demographics
NPI:1083974984
Name:IMAGE DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:IMAGE DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
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:732-777-2588
Mailing Address - Street 1:2 KENNEDY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-777-2588
Mailing Address - Fax:732-839-1071
Practice Address - Street 1:2 KENNEDY BOULEVARD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-777-2588
Practice Address - Fax:732-839-1071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACULABS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier