Provider Demographics
NPI:1740599042
Name:DWF IMAGING LLC
Entity Type:Organization
Organization Name:DWF IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-692-9631
Mailing Address - Street 1:87 BERDAN AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 BERDAN AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3210
Practice Address - Country:US
Practice Address - Phone:973-692-9631
Practice Address - Fax:973-692-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA063220002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8651400Medicaid