Provider Demographics
NPI:1598705840
Name:SAINT BARNABAS OUTPATIENT CENTERS
Entity Type:Organization
Organization Name:SAINT BARNABAS OUTPATIENT CENTERS
Other - Org Name:BREAST AND WOMEN'S IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-322-7331
Mailing Address - Street 1:1050 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7983
Mailing Address - Country:US
Mailing Address - Phone:908-206-2230
Mailing Address - Fax:908-206-2237
Practice Address - Street 1:1 ROBERTSON DR
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1716
Practice Address - Country:US
Practice Address - Phone:908-234-0205
Practice Address - Fax:908-470-3680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT BARNABAS OUTPATIENT CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24425261QM1200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8119201Medicaid
NJ118521Medicare Oscar/Certification