=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326275108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUDSON RADIOLOGY CENTER OF NJ
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2009
-----------------------------------------------------
Last Update Date | 06/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 657 BROADWAY
-----------------------------------------------------
City | BAYONNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-437-3007
-----------------------------------------------------
Fax | 201-437-1418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 657 BROADWAY
-----------------------------------------------------
City | BAYONNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-437-3007
-----------------------------------------------------
Fax | 201-437-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTATOR
-----------------------------------------------------
Name | LOUISE SYPERSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-437-3007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | 23347
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------