Provider Demographics
NPI:1730137381
Name:FASTRAD LLC
Entity Type:Organization
Organization Name:FASTRAD LLC
Other - Org Name:FASTRAD LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEXLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-594-1001
Mailing Address - Street 1:101 NORTH 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211
Mailing Address - Country:US
Mailing Address - Phone:718-594-1001
Mailing Address - Fax:718-594-1001
Practice Address - Street 1:101 NORTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211
Practice Address - Country:US
Practice Address - Phone:718-594-1001
Practice Address - Fax:718-594-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0173371Medicaid
NY02830528Medicaid
NY02830528Medicaid
NY07712Medicare PIN
NYBA0901Medicare ID - Type UnspecifiedHEALTHNOW
NYFR0O971010Medicare PIN
NJ113633Medicare PIN
NYO97101Medicare PIN