Provider Demographics
NPI:1912975079
Name:MOBILE DIAGNOSTIC SERVICES INC
Entity type:Organization
Organization Name:MOBILE DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDREICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-812-1300
Mailing Address - Street 1:144 N BEVERWYCK RD
Mailing Address - Street 2:PMB 334
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-1909
Mailing Address - Country:US
Mailing Address - Phone:973-812-1300
Mailing Address - Fax:973-812-0992
Practice Address - Street 1:40 GALESI DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4826
Practice Address - Country:US
Practice Address - Phone:973-812-1300
Practice Address - Fax:973-812-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3378501Medicaid
NJ3378501Medicaid