Provider Demographics
NPI:1972703080
Name:VALLEY LO IMAGING CO.
Entity Type:Organization
Organization Name:VALLEY LO IMAGING CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNEYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-845-0909
Mailing Address - Street 1:PO BOX 2068
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6068
Mailing Address - Country:US
Mailing Address - Phone:847-845-0909
Mailing Address - Fax:
Practice Address - Street 1:1965 TANGLEWOOD DR
Practice Address - Street 2:UNIT F
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1636
Practice Address - Country:US
Practice Address - Phone:847-845-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty