Provider Demographics
NPI:1831364405
Name:PORTABLE IMAGING SERVICES, LLC
Entity type:Organization
Organization Name:PORTABLE IMAGING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY TECHNOLOGIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAVIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:1917-721-9418
Mailing Address - Street 1:2770 YATES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5331
Mailing Address - Country:US
Mailing Address - Phone:917-721-9418
Mailing Address - Fax:
Practice Address - Street 1:2770 YATES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5331
Practice Address - Country:US
Practice Address - Phone:917-721-9418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051655335V00000X, 247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty