Provider Demographics
NPI:1841522281
Name:MOLECULAR NEUROIMAGING, LLC
Entity type:Organization
Organization Name:MOLECULAR NEUROIMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-431-4351
Mailing Address - Street 1:60 TEMPLE ST
Mailing Address - Street 2:#8A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2716
Mailing Address - Country:US
Mailing Address - Phone:203-401-4300
Mailing Address - Fax:203-401-4304
Practice Address - Street 1:60 TEMPLE ST
Practice Address - Street 2:#8A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2716
Practice Address - Country:US
Practice Address - Phone:203-401-4300
Practice Address - Fax:203-401-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty