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General NPI Number Information
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NPI Number | 1114957016
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Entity Type | Organization
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Legal Business Name | HOBOKEN RADIOLOGY, LLC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 79 HUDSON ST SUITE 100
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City | HOBOKEN
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State | NJ
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Zip | 07030-5638
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Country | US
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Telephone | 201-222-2500
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Fax | 201-469-0555
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Provider Business Mailing Address
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Address Line | 79 HUDSON ST SUITE 100
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City | HOBOKEN
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State | NJ
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Zip | 07030-5638
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Country | US
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Telephone | 201-222-2500
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Fax | 201-469-0555
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GARY R BERGER
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Credential |
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Telephone | 201-222-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 23188
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License Number State | NJ
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