Provider Demographics
NPI:1164428330
Name:STAT RADIOLOGY LLC
Entity Type:Organization
Organization Name:STAT RADIOLOGY LLC
Other - Org Name:DOVER IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRU
Authorized Official - Middle Name:U
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-240-1011
Mailing Address - Street 1:1166 RIVER AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5600
Mailing Address - Country:US
Mailing Address - Phone:732-364-9565
Mailing Address - Fax:732-364-1908
Practice Address - Street 1:25 MULE RD
Practice Address - Street 2:STE B5&B6
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5035
Practice Address - Country:US
Practice Address - Phone:732-240-1011
Practice Address - Fax:732-240-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
036727Medicare ID - Type UnspecifiedGROUP IDENTIFICATION