Healthcare Provider Details

I. General information

NPI: 1902655400
Provider Name (Legal Business Name): CR MEDI CONSULT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 JUMPING BROOK DR
TOMS RIVER NJ
08755-1002
US

IV. Provider business mailing address

222 JUMPING BROOK DR
TOMS RIVER NJ
08755-1002
US

V. Phone/Fax

Practice location:
  • Phone: 347-684-3120
  • Fax:
Mailing address:
  • Phone: 347-684-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHAIM ROTH
Title or Position: CEO
Credential: RT(R)(CT)
Phone: 347-684-3120