Provider Demographics
NPI:1124266200
Name:ADVANCED MOBILE IMAGING, LLC
Entity type:Organization
Organization Name:ADVANCED MOBILE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ELZIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS,RDMS, RT(R)
Authorized Official - Phone:203-878-6768
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-0416
Mailing Address - Country:US
Mailing Address - Phone:203-878-6768
Mailing Address - Fax:203-878-6087
Practice Address - Street 1:50 CHERRY ST
Practice Address - Street 2:SUITE L
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3487
Practice Address - Country:US
Practice Address - Phone:203-878-6768
Practice Address - Fax:203-878-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003259335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT470000037Medicare PIN