Healthcare Provider Details

I. General information

NPI: 1912925363
Provider Name (Legal Business Name): COLUMBIA DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 PAULISON AVE
CLIFTON NJ
07015
US

IV. Provider business mailing address

1111 PAULISON AVE
CLIFTON NJ
07015
US

V. Phone/Fax

Practice location:
  • Phone: 973-340-7171
  • Fax: 973-340-7272
Mailing address:
  • Phone: 973-340-7171
  • Fax: 973-340-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WILLIAM RHOADES
Title or Position: ADMINISTRATOR
Credential:
Phone: 973-340-7171