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General NPI Number Information
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NPI Number | 1679502215
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Entity Type | Organization
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Legal Business Name | 968 RIVER ROAD RADIOLOGY
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 968 RIVER ROAD
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City | EDGEWATER
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State | NJ
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Zip | 07020
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Country | US
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Telephone | 856-616-8100
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Fax | 856-616-1919
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Provider Business Mailing Address
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Address Line | PO BOX 5075
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City | CHERRY HILL
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State | NJ
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Zip | 08034-5075
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Country | US
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Telephone | 856-616-8100
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Fax | 856-616-1919
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Authorized Official
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Title or Position | CHAIRMAN OF RADIOLOGY
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Name | ROBERT S PORT
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Credential | MD
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Telephone | 856-616-8100
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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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