Provider Demographics
NPI:1033470661
Name:DIAGNOSTIC SERVICES OF NEW JERSEY
Entity Type:Organization
Organization Name:DIAGNOSTIC SERVICES OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRICKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-636-2660
Mailing Address - Street 1:96 LINWOOD PLZ
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3701
Mailing Address - Country:US
Mailing Address - Phone:201-724-5367
Mailing Address - Fax:800-218-4632
Practice Address - Street 1:96 LINWOOD PLZ
Practice Address - Street 2:SUITE 302
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3701
Practice Address - Country:US
Practice Address - Phone:201-724-5367
Practice Address - Fax:800-218-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty