MEDICARE: NORTH HUDSON RADIOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1174892749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH HUDSON RADIOLOGY

Provider Business Mailing Address
First Line	:	600 79TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4964
Country	:	US
Telephone Number	:	201-725-2976
Fax Number	:	201-861-5924

Provider Business Practice Location Address
First Line	:	2100 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-2127
Country	:	US
Telephone Number	:	201-906-4094
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. GINA M MIRANDA-DIAZ
Credential	:	RN, MSN, MPH
Telephone Number	:	201-906-4094

Provider Enumeration Date	:	12/27/2011
Last Update Date	:	12/27/2011

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