1598794463 NPI number — RED BANK RADIOLOGISTS, PA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598794463 NPI number — RED BANK RADIOLOGISTS, PA

Employer Identification Number (EIN):

Provider Organization Name:

RED BANK RADIOLOGISTS, PA

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

SAME

Provider Other Organization Name Type Code:

3

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1598794463

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

05/05/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6 RIVERVIEW PLAZA

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

RED BANK

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07701-0476

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

732-747-1429

Provider Business Mailing Address Fax Number:

732-747-4778

Provider First Line Business Practice Location Address:

200 WHITE RD STE 115

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LITTLE SILVER

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07739-1160

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

737-741-9595

Provider Business Practice Location Address Fax Number:

737-741-0985

Provider Enumeration Date:

07/02/2006

Authorized Official Last Name:

WOLD

Authorized Official First Name:

ROBERT

Authorized Official Middle Name:

E

Authorized Official Title or Position:

VICE PRESIDENT

Authorized Official Telephone Number:

732-741-9595

• Taxonomy code: 2085R0202X , with the licence number:  101844 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1072590 . This is a "HORIZON MERCY NJ HEALTH P" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 17368 . This is a "AETNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 0094480 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0179417 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 2617005 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 074428 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 23088 . This is a "AMERIGROUP" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: OK8987 . This is a "HEALTH NET" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
• Identifier: 0094480 . This is a "GHI" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: CF1683 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".