Electrodiagnostic Imaging LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

ELECTRODIAGNOSTIC IMAGING LLC

Practice address

12 Taylor Avenue
Carteret, NJ 07008

Phone

(732) 541-2108

Fax

(908) 688-8180

NPI assigned

Oct 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Shortell

Title

Administrator

Phone

(201) 610-9559

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972696607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 TAYLOR AVENUE",
            "city": "CARTERET",
            "state": "NJ",
            "postal_code": "07008",
            "telephone_number": "732-541-2108",
            "fax_number": "908-688-8180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 TAYLOR AVENUE",
            "city": "CARTERET",
            "state": "NJ",
            "postal_code": "07008",
            "telephone_number": "732-541-2108",
            "fax_number": "908-688-8180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELECTRODIAGNOSTIC IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHORTELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "201-610-9559",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.