Provider Demographics
NPI:1659529584
Name:EASTERN PORTABLE X-RAY CORP.
Entity Type:Organization
Organization Name:EASTERN PORTABLE X-RAY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BONET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-563-7777
Mailing Address - Street 1:14469 SW 43RD COURT RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-2333
Mailing Address - Country:US
Mailing Address - Phone:800-684-5800
Mailing Address - Fax:
Practice Address - Street 1:14469 SW 43RD COURT RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-2333
Practice Address - Country:US
Practice Address - Phone:800-684-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier