Healthcare Provider Details

I. General information

NPI: 1225334659
Provider Name (Legal Business Name): RGM MULTIPLE DIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 KENNEDY BLVD SUITE 200
WEST NEW YORK NJ
07093
US

IV. Provider business mailing address

10 DELMAR RD
JERSEY CITY NJ
07305-1208
US

V. Phone/Fax

Practice location:
  • Phone: 201-780-4653
  • Fax:
Mailing address:
  • Phone: 201-780-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: FARRUKH BABAR
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 201-780-4653