Provider Demographics
NPI:1114057288
Name:BJ DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:BJ DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-585-8372
Mailing Address - Street 1:PO BOX 9293
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60598-9293
Mailing Address - Country:US
Mailing Address - Phone:630-585-8372
Mailing Address - Fax:630-585-8372
Practice Address - Street 1:1608 W 69TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-3316
Practice Address - Country:US
Practice Address - Phone:773-471-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL535120Medicare ID - Type Unspecified