Provider Demographics
NPI:1548207236
Name:CENTRAL OCEAN COUNTY DIAGNOSTIC IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:CENTRAL OCEAN COUNTY DIAGNOSTIC IMAGING CENTER, LLC
Other - Org Name:CENTRAL OCEAN IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:609-971-1606
Mailing Address - Street 1:5 LACEY RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731
Mailing Address - Country:US
Mailing Address - Phone:609-971-1606
Mailing Address - Fax:609-971-1632
Practice Address - Street 1:5 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-4238
Practice Address - Country:US
Practice Address - Phone:609-971-1606
Practice Address - Fax:609-971-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23357261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0053295Medicaid
NJ087758Medicare ID - Type Unspecified