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General NPI Number Information
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NPI Number | 1396163374
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Entity Type | Organization
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Legal Business Name | NEXT GENERATION DIAGNOSTIC IMAGING PC
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 360 SPRINGFIELD AVE SUITE 302B
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City | SUMMIT
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State | NJ
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Zip | 07901-4608
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Country | US
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Telephone | 973-969-6900
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Fax | 609-949-5555
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Provider Business Mailing Address
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Address Line | 360 SPRINGFIELD AVE SUITE 302B
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City | SUMMIT
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State | NJ
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Zip | 07901-4608
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Country | US
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Telephone | 973-969-6900
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Fax | 609-949-5555
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD DENISE
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Credential | M.D.
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Telephone | 973-969-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA08524500
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License Number State | NJ
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