Provider Demographics
NPI:1124616297
Name:BURLINGTON DIAGNOSTIC IMAGING LLC
Entity type:Organization
Organization Name:BURLINGTON DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:NAZISH
Authorized Official - Middle Name:N
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-990-9336
Mailing Address - Street 1:2800 ROUTE 130 N # UITE202
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3035
Mailing Address - Country:US
Mailing Address - Phone:215-990-9336
Mailing Address - Fax:
Practice Address - Street 1:2800 ROUTE 130 N STE 202
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-3035
Practice Address - Country:US
Practice Address - Phone:215-990-9336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450556535OtherDEPARTMENT OF TREASURY DIVISION OF REVENUE STATE OF NEW JERSEY