Provider Demographics
NPI:1285659862
Name:HACKETTSTOWN DIAGNOSTIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:HACKETTSTOWN DIAGNOSTIC ASSOCIATES LLC
Other - Org Name:HACKETTSTOWN DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-979-1621
Mailing Address - Street 1:254 B MOUNTAIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-979-1621
Mailing Address - Fax:908-979-1622
Practice Address - Street 1:254 B MOUNTAIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-979-1621
Practice Address - Fax:908-979-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23084261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology