Provider Demographics
NPI:1053773549
Name:NORTHEAST VASCULAR IMAGING GROUP INC
Entity type:Organization
Organization Name:NORTHEAST VASCULAR IMAGING GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-698-9700
Mailing Address - Street 1:25 BRIDLEWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1701
Mailing Address - Country:US
Mailing Address - Phone:518-698-9700
Mailing Address - Fax:518-280-4735
Practice Address - Street 1:25 BRIDLEWOOD LOOP
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1701
Practice Address - Country:US
Practice Address - Phone:518-698-9700
Practice Address - Fax:518-280-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty