Provider Demographics
NPI:1356527436
Name:MOBILERAD, INC.
Entity type:Organization
Organization Name:MOBILERAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KIRCHER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:631-642-2240
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-0708
Mailing Address - Country:US
Mailing Address - Phone:631-642-2240
Mailing Address - Fax:631-331-9868
Practice Address - Street 1:27 TIMBERLINE CIR # CL
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1440
Practice Address - Country:US
Practice Address - Phone:631-642-2240
Practice Address - Fax:631-331-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY51023476335V00000X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02935037Medicaid
NY02333842Medicaid