Provider Demographics
NPI:1669527032
Name:ADVANCED RADIOLOGY OF RIVERWINDS, LLC
Entity type:Organization
Organization Name:ADVANCED RADIOLOGY OF RIVERWINDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-983-5599
Mailing Address - Street 1:100 BRICK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2146
Mailing Address - Country:US
Mailing Address - Phone:856-415-0413
Mailing Address - Fax:856-985-9061
Practice Address - Street 1:100 BRICK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-415-0413
Practice Address - Fax:856-985-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB062604002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095881Medicare ID - Type UnspecifiedMEDICARE NUMBER