| Organization Name: | SAM RADIOLOGY SERVICES LLC |
| NPI Number: | 1295967453 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FAZLOLLAH GOLESTANEH (OWNER/PRESIDENT) |
| Mailing Address: | 66 Tanner St Haddonfield |
| State: | NJ US |
| Postal Code: | 080332419 |
| Phone Number: | 8565079512 |
| Fax Number: | 8565079516 |
| NPI Enumeration Date: | 08/20/2009 |
| NPI Last Update Date: | 08/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | 25MA03109900 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |