Organization
SAM RADIOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAZLOLLAH GOLESTANEH MD (OWNER/PRESIDENT)
(856) 507-9512
Entity
Organization
Contact information
Practice address
66 TANNER ST, HADDONFIELD, NJ 08033-2419
(856) 507-9512
(856) 507-9516
Mailing address
66 TANNER ST, HADDONFIELD, NJ 08033-2419
(856) 507-9512
(856) 507-9516
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
25MA03109900
NJ
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
25MA03109900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2323206
—
NJ
Enumeration date
08/20/2009
Last updated
08/20/2009
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