Healthcare Provider Details

I. General information

NPI: 1114957016
Provider Name (Legal Business Name): HOBOKEN RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HUDSON ST SUITE 100
HOBOKEN NJ
07030-5638
US

IV. Provider business mailing address

79 HUDSON ST SUITE 100
HOBOKEN NJ
07030-5638
US

V. Phone/Fax

Practice location:
  • Phone: 201-222-2500
  • Fax: 201-469-0555
Mailing address:
  • Phone: 201-222-2500
  • Fax: 201-469-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number23188
License Number StateNJ

VIII. Authorized Official

Name: MR. GARY R BERGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 201-222-2500