Provider Demographics
NPI:1912247966
Name:SDNJ RADIOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:SDNJ RADIOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:COUREY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-577-0555
Mailing Address - Street 1:224 TAYLORS MILLS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3281
Mailing Address - Country:US
Mailing Address - Phone:732-577-0555
Mailing Address - Fax:732-577-8555
Practice Address - Street 1:224 TAYLORS MILLS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3281
Practice Address - Country:US
Practice Address - Phone:732-577-0555
Practice Address - Fax:732-577-8555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES COUREY DDS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ185971223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty