| NPI | 1164466926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA L CONCEPCION Credentialing Speacialist 201-836-2509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0206X Clinic/Center, Radiology, Mammography (Licence: NJ 24115) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology (Licence: NJ 24115) |
| 261QR0208X Clinic/Center, Radiology, Mobile (Licence: NJ 24115) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-08-22 |