Provider Demographics
NPI:1063516631
Name:MD MOBILE LLC
Entity type:Organization
Organization Name:MD MOBILE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RALUCA
Authorized Official - Middle Name:
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-585-5170
Mailing Address - Street 1:1 SCENIC DR
Mailing Address - Street 2:SUITE 907
Mailing Address - City:HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07732-1329
Mailing Address - Country:US
Mailing Address - Phone:201-788-4962
Mailing Address - Fax:
Practice Address - Street 1:1 SCENIC DR
Practice Address - Street 2:SUITE 907
Practice Address - City:HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07732-1329
Practice Address - Country:US
Practice Address - Phone:201-788-4962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073751261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080639Medicare ID - Type UnspecifiedSOUTH
NJ080638Medicare ID - Type UnspecifiedNORTH