Provider Demographics
NPI:1093187833
Name:WAYNE RADIOLOGY CENTER LLC
Entity Type:Organization
Organization Name:WAYNE RADIOLOGY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDALLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JALOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-942-5714
Mailing Address - Street 1:516 HAMBURG TPKE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2062
Mailing Address - Country:US
Mailing Address - Phone:973-942-5714
Mailing Address - Fax:
Practice Address - Street 1:516 HAMBURG TPKE
Practice Address - Street 2:SUITE 6
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2062
Practice Address - Country:US
Practice Address - Phone:973-942-5714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology