Provider Demographics
NPI:1497988448
Name:RADIOLOGY PROFESSIONAL SERVICES, P.C.
Entity Type:Organization
Organization Name:RADIOLOGY PROFESSIONAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-413-1004
Mailing Address - Street 1:1601 N 2ND ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1924
Mailing Address - Country:US
Mailing Address - Phone:856-413-1004
Mailing Address - Fax:856-327-3339
Practice Address - Street 1:1601 N 2ND ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1924
Practice Address - Country:US
Practice Address - Phone:856-413-1004
Practice Address - Fax:856-327-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty