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General NPI Number Information
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NPI Number | 1639136914
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD RADIOLOGIC GROUP P A
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 350 ENGLE ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631
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Country | US
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Telephone | 201-894-3400
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Fax | 201-894-5244
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Provider Business Mailing Address
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Address Line | 350 ENGLE ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631
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Country | US
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Telephone | 201-894-3400
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Fax | 201-894-5244
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Authorized Official
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Title or Position | CHIEF DEPT OF RADIOLOGY
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Name | MARK SHAPIRO
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Credential | MD
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Telephone | 201-894-3480
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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 |
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License Number State |
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