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Organization
KM RADIOLOGY, LLC
Active
Organization
KM RADIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KETANG H MODI D.O. (MANAGING MEMBER)
(973) 595-7112
Entity
Organization
Contact information
Practice address
23 MOUNTAINVIEW CT, TOTOWA, NJ 07512-1654
(973) 595-7112
Mailing address
23 MOUNTAINVIEW CT, TOTOWA, NJ 07512-1654
(973) 595-7112
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
25MB07370200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059431BSQ
MEDICARE ID#
—
01
—
1396736468
INDIVIDUAL NPI
NJ
05
—
8900507
—
NJ
Enumeration date
08/13/2010
Last updated
08/13/2010
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