Healthcare Provider Details

I. General information

NPI: 1619065612
Provider Name (Legal Business Name): RADIOLOGY PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 PALISADE AVE SUITE 106
JERSEY CITY NJ
07306-1133
US

IV. Provider business mailing address

142 PALISADE AVE SUITE 106
JERSEY CITY NJ
07306-1133
US

V. Phone/Fax

Practice location:
  • Phone: 201-795-8187
  • Fax: 201-795-0018
Mailing address:
  • Phone: 201-795-8187
  • Fax: 201-795-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number22210
License Number StateNJ

VIII. Authorized Official

Name: DR. ALAN M SHAIMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-795-8187