Provider Demographics
NPI:1861969388
Name:GARDEN STATE DIAGNOSTIC IMAGING
Entity type:Organization
Organization Name:GARDEN STATE DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-452-4485
Mailing Address - Street 1:6 EARLIN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-1768
Mailing Address - Country:US
Mailing Address - Phone:609-836-5313
Mailing Address - Fax:609-836-5444
Practice Address - Street 1:6 EARLIN AVENUE
Practice Address - Street 2:160
Practice Address - City:BROWN MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015
Practice Address - Country:US
Practice Address - Phone:609-836-5319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)