Provider Demographics
NPI:1568660009
Name:MARAYAH DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:MARAYAH DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:HASAN
Authorized Official - Last Name:MATARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-224-6870
Mailing Address - Street 1:7247 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-1821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7247 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1821
Practice Address - Country:US
Practice Address - Phone:708-224-6870
Practice Address - Fax:708-636-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology