Provider Demographics
NPI:1336468065
Name:NORTH SHORE MOBILE RADIOGRAPHY & TESTING, INC
Entity Type:Organization
Organization Name:NORTH SHORE MOBILE RADIOGRAPHY & TESTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAINES
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LRT
Authorized Official - Phone:516-676-5264
Mailing Address - Street 1:120 WOOLSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1808
Mailing Address - Country:US
Mailing Address - Phone:516-676-5264
Mailing Address - Fax:516-676-5264
Practice Address - Street 1:120 WOOLSEY AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1808
Practice Address - Country:US
Practice Address - Phone:516-776-2097
Practice Address - Fax:516-676-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY449221335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier