Healthcare Provider Details

I. General information

NPI: 1902135601
Provider Name (Legal Business Name): ULTRASOUND DIAGNOSTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HERITAGE CT
BASKING RIDGE NJ
07920-4801
US

IV. Provider business mailing address

6 HERITAGE CT
BASKING RIDGE NJ
07920-4801
US

V. Phone/Fax

Practice location:
  • Phone: 201-913-5475
  • Fax:
Mailing address:
  • Phone: 201-913-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number1765
License Number StateNJ

VIII. Authorized Official

Name: MR. ANTHONY GASALBERTI
Title or Position: PRESIDENT
Credential: RDMS
Phone: 201-913-5475