Provider Demographics
NPI:1306382254
Name:ROBERT WOOD JOHNSON JR LIFESTYLE INSTITUTE INC
Entity Type:Organization
Organization Name:ROBERT WOOD JOHNSON JR LIFESTYLE INSTITUTE INC
Other - Org Name:JFK ADVANCED MEDICAL IMAGING OF TOMS RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-321-7747
Mailing Address - Street 1:80 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3938
Mailing Address - Country:US
Mailing Address - Phone:732-321-7000
Mailing Address - Fax:732-318-3693
Practice Address - Street 1:1430 HOOPER AVENUE
Practice Address - Street 2:#102
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-349-2867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology