Provider Demographics
NPI:1003128968
Name:ATLANTIC IMAGING GROUP, LLC
Entity type:Organization
Organization Name:ATLANTIC IMAGING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DEGASPERIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-451-9415
Mailing Address - Street 1:110 S JEFFERSON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1038
Mailing Address - Country:US
Mailing Address - Phone:973-451-9415
Mailing Address - Fax:
Practice Address - Street 1:110 S JEFFERSON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1038
Practice Address - Country:US
Practice Address - Phone:973-451-9415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization