MEDICARE: HUDSON RIVER RADIOLOGY CENTER LLC

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	261QR0206X	Mammography Clinic/Center	23951	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	:	1710350798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON RIVER RADIOLOGY CENTER LLC

Provider Business Mailing Address
First Line	:	120 48TH ST # 152
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-6439
Country	:	US
Telephone Number	:	201-758-8035
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 48TH ST # 152
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-6439
Country	:	US
Telephone Number	:	201-758-8035
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAWAB H ZUBERI
Credential	:
Telephone Number	:	201-758-8035

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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