Provider Demographics
NPI:1598794463
Name:RED BANK RADIOLOGISTS, PA
Entity Type:Organization
Organization Name:RED BANK RADIOLOGISTS, PA
Other - Org Name:SAME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-9595
Mailing Address - Street 1:6 RIVERVIEW PLAZA
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0476
Mailing Address - Country:US
Mailing Address - Phone:732-747-1429
Mailing Address - Fax:732-747-4778
Practice Address - Street 1:200 WHITE RD STE 115
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1160
Practice Address - Country:US
Practice Address - Phone:737-741-9595
Practice Address - Fax:737-741-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1018442085R0202X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1072590OtherHORIZON MERCY NJ HEALTH P
NE17368OtherAETNA
NJ0094480OtherGHI
NJ0179417OtherCIGNA
NJ2617005Medicaid
NE074428OtherAMERIHEALTH PPO
NE23088OtherAMERIGROUP
NHOK8987OtherHEALTH NET
NE0094480OtherGHI
NJCF1683OtherRR MEDICARE
NJ2617005Medicaid
NE23088OtherAMERIGROUP
NHOK8987OtherHEALTH NET