Provider Demographics
NPI:1336477322
Name:GARDEN STATE ADVANCED IMAGING, LLC
Entity Type:Organization
Organization Name:GARDEN STATE ADVANCED IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-294-1426
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-0675
Mailing Address - Country:US
Mailing Address - Phone:201-294-1426
Mailing Address - Fax:201-261-6276
Practice Address - Street 1:147 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1209
Practice Address - Country:US
Practice Address - Phone:201-294-1426
Practice Address - Fax:201-261-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology