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General NPI Number Information
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NPI Number | 1336477322
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Entity Type | Organization
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Legal Business Name | GARDEN STATE ADVANCED IMAGING, LLC
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 147 W CENTRAL AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621-1209
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Country | US
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Telephone | 201-294-1426
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Fax | 201-261-6276
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Provider Business Mailing Address
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Address Line | PO BOX 675
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City | BERGENFIELD
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State | NJ
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Zip | 07621-0675
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Country | US
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Telephone | 201-294-1426
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Fax | 201-261-6276
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROGER H. COLETTI
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Credential | MD
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Telephone | 201-294-1426
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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 |
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License Number State |
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