Provider Demographics
NPI:1306969126
Name:J L IMAGING INC
Entity type:Organization
Organization Name:J L IMAGING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHARIFEH
Authorized Official - Suffix:I
Authorized Official - Credentials:ULTRASOUND
Authorized Official - Phone:708-612-6727
Mailing Address - Street 1:11718 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7573
Mailing Address - Country:US
Mailing Address - Phone:708-612-6727
Mailing Address - Fax:708-478-4978
Practice Address - Street 1:11718 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7573
Practice Address - Country:US
Practice Address - Phone:708-612-6727
Practice Address - Fax:708-478-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062091261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062091Medicaid
IL01632972Medicare UPIN