Provider Demographics
NPI:1407069925
Name:RADIOLOGY ASSOCIATES OF HACKETTSTOWN LLC
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF HACKETTSTOWN LLC
Other - Org Name:IMAGECARE AT HACKETTSTOWN RAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HINRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-979-1621
Mailing Address - Street 1:57 ROUTE 46
Mailing Address - Street 2:SUITE 212
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:
Practice Address - Street 1:57 ROUTE 46
Practice Address - Street 2:SUITE 212
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2695
Practice Address - Country:US
Practice Address - Phone:908-979-1621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121225Medicare PIN