Provider Demographics
NPI:1861888117
Name:ULTRA IMAGING
Entity type:Organization
Organization Name:ULTRA IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLEDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BERBERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-864-7846
Mailing Address - Street 1:160 LANZA AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3551
Mailing Address - Country:US
Mailing Address - Phone:973-864-7845
Mailing Address - Fax:973-878-1773
Practice Address - Street 1:160 LANZA AVE STE 10
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3551
Practice Address - Country:US
Practice Address - Phone:973-878-3282
Practice Address - Fax:973-878-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1861888117OtherMEDICARE