Healthcare Provider Details

I. General information

NPI: 1659541316
Provider Name (Legal Business Name): WOMENS IMAGING OF RIDGEWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 CHESTNUT ST
RIDGEWOOD NJ
07450-2563
US

IV. Provider business mailing address

79 CHESTNUT ST
RIDGEWOOD NJ
07450-2563
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-4484
  • Fax: 201-444-4448
Mailing address:
  • Phone: 201-444-4484
  • Fax: 201-444-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number25MA05610100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number25MA05610100
License Number StateNJ

VIII. Authorized Official

Name: DR. LISA R WEINSTOCK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 201-444-4484