Provider Demographics
NPI:1548387947
Name:GARDEN STATE MOLECULAR IMAGING INC
Entity type:Organization
Organization Name:GARDEN STATE MOLECULAR IMAGING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NASH
Authorized Official - Middle Name:N
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:609-581-2727
Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:HAMILTON SQ
Mailing Address - State:NJ
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:609-581-2727
Mailing Address - Fax:609-581-3772
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 403
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:609-581-2727
Practice Address - Fax:609-581-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology