Provider Demographics
NPI:1710931852
Name:DOSHI DIAGNOSTIC IMAGING SERVICES OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:DOSHI DIAGNOSTIC IMAGING SERVICES OF NEW JERSEY, LLC
Other - Org Name:DOSHI DIAGNOSTIC IMAGING SERVICES OF NJ LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTHNASWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-383-0500
Mailing Address - Street 1:P.O. BOX 1036
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201
Mailing Address - Country:US
Mailing Address - Phone:609-383-0500
Mailing Address - Fax:609-383-0376
Practice Address - Street 1:434 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-2423
Practice Address - Country:US
Practice Address - Phone:609-383-0500
Practice Address - Fax:609-383-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ230522085R0202X, 2085R0202X
NJ225142085R0202X
NJ224262085R0202X
NJ227722085R0202X
NJ241292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0115720Medicaid
NJ120503Medicare PIN
NJ121306Medicare PIN
NJ108237Medicare PIN
NJ120511Medicare PIN
NJ0115720Medicaid
NJ120552Medicare PIN