Healthcare Provider Details

I. General information

NPI: 1164428330
Provider Name (Legal Business Name): STAT RADIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MULE RD STE B5&B6
TOMS RIVER NJ
08755-5035
US

IV. Provider business mailing address

1166 RIVER AVE STE 102
LAKEWOOD NJ
08701-5600
US

V. Phone/Fax

Practice location:
  • Phone: 732-240-1011
  • Fax: 732-240-3309
Mailing address:
  • Phone: 732-364-9565
  • Fax: 732-364-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHANDRU U JAIN
Title or Position: PARTNER
Credential: M.D.
Phone: 732-240-1011