Provider Demographics
NPI:1841592656
Name:FAST RESPONSE PORTABLE IMAGING, LLC
Entity Type:Organization
Organization Name:FAST RESPONSE PORTABLE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-263-3745
Mailing Address - Street 1:100 CHALLENGER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2108
Mailing Address - Country:US
Mailing Address - Phone:727-337-6101
Mailing Address - Fax:727-213-6250
Practice Address - Street 1:10 N MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4533
Practice Address - Country:US
Practice Address - Phone:727-337-6101
Practice Address - Fax:727-213-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9044261QR0208X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1053642314OtherMEDICARE 855B