Basic Information
| Provider Information | |||||||||
| NPI: | 1790013324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC IMAGING SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 SYCAMORE LN | ||||||||
| Address2: | |||||||||
| City: | RUMSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077601035 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4 SYCAMORE LN | ||||||||
| Address2: | |||||||||
| City: | RUMSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077601035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2009 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | GIBBENS | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9999999999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 25MA06225500 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.