Provider Demographics
NPI:1881384865
Name:ADVANCED DIAGNOSTIC IMAGING OF NEW JERSEY INC
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING OF NEW JERSEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-349-0447
Mailing Address - Street 1:34 N RTE 17
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2727
Mailing Address - Country:US
Mailing Address - Phone:973-349-0447
Mailing Address - Fax:
Practice Address - Street 1:34 N RTE 17
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2727
Practice Address - Country:US
Practice Address - Phone:973-349-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22548OtherAMBULATORY CARE FACILITY LICENSE