Basic Information
| Provider Information | |||||||||
| NPI: | 1104182484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ULTIMATE SONO IMAGING INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 NEW BRUNSWICK AVE STE 208 | ||||||||
| Address2: | |||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088614172 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 133 NEW BRUNSWICK AVE STE 208 | ||||||||
| Address2: | |||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088614172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173711020 | ||||||||
| FaxNumber: | 7187437337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2012 | ||||||||
| LastUpdateDate: | 04/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | G. | ||||||||
| AuthorizedOfficialFirstName: | MAGGIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALER | ||||||||
| AuthorizedOfficialTelephone: | 7187437090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.