National Provider Identifier Database

BROADWAY IMAGING MEDICAL CENTER
Diagnostic Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.


Contact Information

BROADWAY IMAGING MEDICAL CENTER
140 NORTH GLENDALE AVE
GLENDALE, CA91206
Phone: 818-548-0022
Fax: 818-548-8385
Website:
Specialty Taxonomy Code
* Diagnostic Radiology 2085R0202X
Magnetic Resonance Imaging (MRI) 207RM1200X

* Indicates primary specialty

NPI Profile & details for BROADWAY IMAGING MEDICAL CENTER

NPI Number 1497708002
Legal business name
LBN
BROADWAY IMAGING MEDICAL CENTER
Authorized official HOSAM MOUSTAFA - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 05/18/2006
Last updated 08/12/2018 - About 8 years ago
Sole proprietor1 Not specified
Identifiers
  • CA License #: A71010
  • CA Medicaid: 00A710100

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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