1114957016 NPI number — HOBOKEN RADIOLOGY, LLC

Table of content: (NPI 1114957016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114957016 NPI number — HOBOKEN RADIOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOBOKEN RADIOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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 Information

NPI Number:
1114957016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79 HUDSON ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HOBOKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07030-5638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-222-2500
Provider Business Mailing Address Fax Number:
201-469-0555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 HUDSON ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOBOKEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07030-5638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-222-2500
Provider Business Practice Location Address Fax Number:
201-469-0555
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERGER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
201-222-2500

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  23188 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0043001 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2280953000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: A3197301 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7013612 . This is a "AETNA GOLDEN CHOICE/MEDIC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 036754 . This is a "CIGNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1600372 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3606490 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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