Provider Demographics
NPI:1598490294
Name:IRVINGTON MOBILE IMAGING
Entity Type:Organization
Organization Name:IRVINGTON MOBILE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:190-886-8120
Mailing Address - Street 1:145 OLD STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5829
Mailing Address - Country:US
Mailing Address - Phone:201-415-1978
Mailing Address - Fax:201-415-1978
Practice Address - Street 1:145 OLD STIRLING RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5829
Practice Address - Country:US
Practice Address - Phone:197-337-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier