Provider Demographics
NPI:1750475802
Name:POINT PLEASANT RADIOLOGY GROUP
Entity Type:Organization
Organization Name:POINT PLEASANT RADIOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-974-8011
Mailing Address - Street 1:PO BOX 3131
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-6131
Mailing Address - Country:US
Mailing Address - Phone:732-974-8011
Mailing Address - Fax:732-974-8820
Practice Address - Street 1:425 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7732
Practice Address - Country:US
Practice Address - Phone:732-974-8011
Practice Address - Fax:732-974-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ303601Medicaid
NJ303601Medicaid