Provider Demographics
NPI:1346295854
Name:SHREWSBURY DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:SHREWSBURY DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR, BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-578-9640
Mailing Address - Street 1:1131 BROAD STREET
Mailing Address - Street 2:SUITE 110 B
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-578-9640
Mailing Address - Fax:732-578-9649
Practice Address - Street 1:1131 BROAD STREET
Practice Address - Street 2:SUITE 110 B
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-578-9640
Practice Address - Fax:732-578-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20864010002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0092622Medicaid
NJ100379Medicare PIN
NJ0092622Medicaid