1164428330 NPI number — STAT RADIOLOGY LLC

Table of content: (NPI 1164428330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164428330 NPI number — STAT RADIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAT 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:
DOVER IMAGING
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 Information

NPI Number:
1164428330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1166 RIVER AVE
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-364-9565
Provider Business Mailing Address Fax Number:
732-364-1908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 MULE RD
Provider Second Line Business Practice Location Address:
STE B5&B6
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08755-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-240-1011
Provider Business Practice Location Address Fax Number:
732-240-3309
Provider Enumeration Date:
06/22/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAIN
Authorized Official First Name:
CHANDRU
Authorized Official Middle Name:
U
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
732-240-1011

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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