Provider Demographics
NPI:1407048689
Name:MICRO DIAGNOSTICS IMAGING INC
Entity Type:Organization
Organization Name:MICRO DIAGNOSTICS IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-689-0400
Mailing Address - Street 1:473 EASTON TURNPIKE
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436
Mailing Address - Country:US
Mailing Address - Phone:570-689-0400
Mailing Address - Fax:570-689-0600
Practice Address - Street 1:473 EASTON TURNPIKE
Practice Address - Street 2:SUITE G
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436
Practice Address - Country:US
Practice Address - Phone:570-689-0400
Practice Address - Fax:570-689-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4346950001Medicare UPIN
PA4346950001Medicare NSC