Healthcare Provider Details

I. General information

NPI: 1497205090
Provider Name (Legal Business Name): ADVANCED DIAGNOSTICS OF NEW JERSEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROUTE 38
CHERRY HILL NJ
08002-2955
US

IV. Provider business mailing address

7632 CITY AVE
PHILADELPHIA PA
19151-2007
US

V. Phone/Fax

Practice location:
  • Phone: 856-486-9000
  • Fax: 856-486-9149
Mailing address:
  • Phone: 215-473-1500
  • Fax: 215-473-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number23487
License Number StateNJ

VIII. Authorized Official

Name: GEORGE L RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 215-473-1500