Provider Demographics
NPI:1083691752
Name:HARBOR MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:HARBOR MEDICAL IMAGING, LLC
Other - Org Name:HARBOR MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADMINISTATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:732-721-5501
Mailing Address - Street 1:540 BORDENTOWN AVE
Mailing Address - Street 2:BOX 2A
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1544
Mailing Address - Country:US
Mailing Address - Phone:732-721-5501
Mailing Address - Fax:732-721-7890
Practice Address - Street 1:127 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3616
Practice Address - Country:US
Practice Address - Phone:201-200-9700
Practice Address - Fax:201-200-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ229582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8963207Medicaid
NJ22958OtherDEPT OF HEALTH/HUMAN SER
NJ8963207Medicaid