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General NPI Number Information
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NPI Number | 1851675797
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Entity Type | Organization
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Legal Business Name | JEM BREAST AND WOMEN'S IMAGING LLC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1275 HIGHWAY 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2040
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Country | US
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Telephone | 732-706-5200
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Fax | 732-706-5204
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Provider Business Mailing Address
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Address Line | 1275 HIGHWAY 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2040
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Country | US
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Telephone | 732-706-5200
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Fax | 732-706-5204
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Authorized Official
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Title or Position | SOLE MBR
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Name | DR. SALVATORE RACCUIA
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Credential | MD
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Telephone | 732-706-5200
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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 | 25MA07886900
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License Number State | NJ
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