Provider Demographics
NPI:1356421747
Name:WOMENS MAMMOGRAPHY CTR CORP
Entity type:Organization
Organization Name:WOMENS MAMMOGRAPHY CTR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:YETSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-252-1880
Mailing Address - Street 1:121 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5744
Mailing Address - Country:US
Mailing Address - Phone:908-782-4700
Mailing Address - Fax:908-237-9210
Practice Address - Street 1:121 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5744
Practice Address - Country:US
Practice Address - Phone:908-782-4700
Practice Address - Fax:908-237-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ148064261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ116562Medicare PIN