Provider Demographics
NPI:1972696607
Name:ELECTRODIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:ELECTRODIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-610-9559
Mailing Address - Street 1:12 TAYLOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008
Mailing Address - Country:US
Mailing Address - Phone:732-541-2108
Mailing Address - Fax:908-688-8180
Practice Address - Street 1:12 TAYLOR AVENUE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008
Practice Address - Country:US
Practice Address - Phone:732-541-2108
Practice Address - Fax:908-688-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory