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Organization
IMAGING SPECIALISTS, LLC
Active
Organization
IMAGING SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETANG MODI DO (MANAGING MEMBER)
(201) 310-2957
Entity
Organization
Contact information
Practice address
111 NORTHFIELD AVE STE 207, WEST ORANGE, NJ 07052-4703
(800) 689-3275
Mailing address
2204 MORRIS AVE STE 204, UNION, NJ 07083-5914
(201) 310-2957
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227706
MEDICARE PTAN
NJ
05
—
430293
—
NJ
Enumeration date
08/17/2011
Last updated
01/15/2024
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