Provider Demographics
NPI:1649418906
Name:ADVANCED MOBILE IMAGING LLC
Entity type:Organization
Organization Name:ADVANCED MOBILE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRION
Authorized Official - Middle Name:
Authorized Official - Last Name:ESULTO
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:201-338-0264
Mailing Address - Street 1:15 STELLING AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-2124
Mailing Address - Country:US
Mailing Address - Phone:201-338-0264
Mailing Address - Fax:866-205-1988
Practice Address - Street 1:15 STELLING AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-2124
Practice Address - Country:US
Practice Address - Phone:201-338-0264
Practice Address - Fax:866-205-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-25
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile