MEDICARE: CRANFORD DIAGNOSTIC IMAGING PA

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	2085R0202X	Diagnostic Radiology Physician		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366436552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANFORD DIAGNOSTIC IMAGING PA

Provider Business Mailing Address
First Line	:	1455 BROAD ST
Second Line	:	CRANFORD DIAGNOSTIC IMAGING PA 4TH FLOOR
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003
Country	:	US
Telephone Number	:	973-873-9889
Fax Number	:	973-707-1127

Provider Business Practice Location Address
First Line	:	25 S UNION AVE
Second Line	:	CRANFORD DIAGNOSTIC IMAGING
City	:	CRANFORD
State	:	NJ
Zip	:	07016
Country	:	US
Telephone Number	:	908-709-1323
Fax Number	:	908-709-1329

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID L BLOOM
Credential	:	MD
Telephone Number	:	617-236-0220

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/21/2022

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