Provider Demographics
NPI:1619085990
Name:GARDEN STATE MAGNETIC IMAGING, P.C.
Entity Type:Organization
Organization Name:GARDEN STATE MAGNETIC IMAGING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:NASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:609-581-2727
Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3831
Mailing Address - Country:US
Mailing Address - Phone:609-581-2727
Mailing Address - Fax:609-581-3772
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 403
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3831
Practice Address - Country:US
Practice Address - Phone:609-581-2727
Practice Address - Fax:609-581-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23114261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086066Medicare ID - Type UnspecifiedGROUP ID