Healthcare Provider Details

I. General information

NPI: 1063470920
Provider Name (Legal Business Name): JOSE LUIS FERREIRA SR. RT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HAMILTON PL
NEW YORK NY
10031-6801
US

IV. Provider business mailing address

50 S MICHIGAN AVE
KENILWORTH NJ
07033-1739
US

V. Phone/Fax

Practice location:
  • Phone: 908-884-0616
  • Fax: 908-634-4797
Mailing address:
  • Phone: 888-964-0088
  • Fax: 917-634-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number092842
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number626344
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: