Provider Demographics
NPI:1710256276
Name:AZONIC DIAGNOSTIC SONOGRAPHY LLC
Entity Type:Organization
Organization Name:AZONIC DIAGNOSTIC SONOGRAPHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:PITAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAITUM
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RDCS, RVT
Authorized Official - Phone:201-667-0327
Mailing Address - Street 1:592 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2914
Mailing Address - Country:US
Mailing Address - Phone:201-667-0327
Mailing Address - Fax:
Practice Address - Street 1:592 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2914
Practice Address - Country:US
Practice Address - Phone:201-667-0327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty