Healthcare Provider Details

I. General information

NPI: 1306864343
Provider Name (Legal Business Name): HACKENSACK RADIOLOGY GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE RADIOLOGY DEPT
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

130 KINDERKAMACK RD STE 200
RIVER EDGE NJ
07661-1951
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-2660
  • Fax:
Mailing address:
  • Phone: 201-488-2660
  • Fax: 201-489-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier016815600
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: MOHIT NAIK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-488-2660