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General NPI Number Information
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NPI Number | 1699250142
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Entity Type | Organization
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Legal Business Name | MEDAID RADIOLOGY LLC
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 481 N 13TH ST
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City | NEWARK
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State | NJ
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Zip | 07107-1317
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Country | US
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Telephone | 973-481-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 481 N 13TH ST
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City | NEWARK
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State | NJ
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Zip | 07107-1317
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Country | US
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Telephone | 973-481-7770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REUVEN ALON
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Credential |
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Telephone | 973-481-7770
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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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