Provider Demographics
NPI:1851704423
Name:DIAGNOSTIC IMAGING AT SADDLE BROOK, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING AT SADDLE BROOK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FITZGERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-519-9523
Mailing Address - Street 1:88 MARKET ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4830
Mailing Address - Country:US
Mailing Address - Phone:201-880-6600
Mailing Address - Fax:201-880-6595
Practice Address - Street 1:88 MARKET ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-4830
Practice Address - Country:US
Practice Address - Phone:201-880-6600
Practice Address - Fax:201-880-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology