Healthcare Provider Details

I. General information

NPI: 1508602152
Provider Name (Legal Business Name): JERSEY CITY IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 JFK BLVD
JERSEY CITY NJ
07304-1510
US

IV. Provider business mailing address

2300 JFK BLVD
JERSEY CITY NJ
07304-1510
US

V. Phone/Fax

Practice location:
  • Phone: 732-376-6616
  • Fax:
Mailing address:
  • Phone: 551-353-9911
  • Fax: 551-256-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BHAVIKA VEDAWALA
Title or Position: OWNER
Credential:
Phone: 908-257-0444