Provider Demographics
NPI:1083660179
Name:1450 ASSOCIATES, LLC
Entity Type:Organization
Organization Name:1450 ASSOCIATES, LLC
Other - Org Name:CENTER FOR DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-794-1700
Mailing Address - Street 1:1450 E. CHESTNUT AVE
Mailing Address - Street 2:BLDG 4
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-8467
Mailing Address - Country:US
Mailing Address - Phone:856-794-1700
Mailing Address - Fax:856-794-2671
Practice Address - Street 1:1450 E. CHESTNUT AVE
Practice Address - Street 2:BLDG 4
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8467
Practice Address - Country:US
Practice Address - Phone:856-794-1700
Practice Address - Fax:856-794-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23263261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
077OtherCARECORE/HEALTHNET
A2891314OtherOXFORD
2K3084OtherHEALTHNET
1156711OtherHORIZON NJ HEALTH
01000441401OtherAMERICHOICE
NJCJ3996OtherRAILROAD MEDICARE
NJ8667802Medicaid
2237566000OtherAMERIHEALTH
S036559OtherCIGNA/AIM
16802OtherAMERIGROUP
NJ8667802Medicaid
2K3084OtherHEALTHNET