Provider Demographics
NPI:1174870323
Name:VITAL SONO IMAGING LLC
Entity type:Organization
Organization Name:VITAL SONO IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALTAF
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESSANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-321-6507
Mailing Address - Street 1:48A GRANDVIEW AVE W
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2522
Mailing Address - Country:US
Mailing Address - Phone:732-321-6507
Mailing Address - Fax:
Practice Address - Street 1:57 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4041
Practice Address - Country:US
Practice Address - Phone:732-321-6507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory