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General NPI Number Information
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NPI Number | 1497700702
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Entity Type | Organization
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Legal Business Name | GARDEN STATE MRI CORP
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 1470 S MAIN RD BUILDING 2
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City | VINELAND
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State | NJ
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Zip | 08360-6588
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Country | US
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Telephone | 856-690-0300
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Fax | 856-205-9925
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Provider Business Mailing Address
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Address Line | PO BOX 1444
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City | VINELAND
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State | NJ
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Zip | 08362-1444
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Country | US
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Telephone | 856-794-2337
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Fax | 856-205-9925
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Authorized Official
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Title or Position | CEO
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Name | DR. RALPH DAUITO
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Credential | M.D.
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Telephone | 856-794-2337
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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 | 25MA05144800
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License Number State | NJ
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