Provider Demographics
NPI:1669740890
Name:AMERICAN IMAGING OF EDISON LLC
Entity type:Organization
Organization Name:AMERICAN IMAGING OF EDISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-474-1111
Mailing Address - Street 1:22 MERIDIAN ROAD
Mailing Address - Street 2:STE 7
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2860
Mailing Address - Country:US
Mailing Address - Phone:732-321-1100
Mailing Address - Fax:732-321-1150
Practice Address - Street 1:1921 OAKTREE ROAD
Practice Address - Street 2:STE 100
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2073
Practice Address - Country:US
Practice Address - Phone:732-474-1111
Practice Address - Fax:732-474-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology