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Organization
TEANECK RADIOLOGY CENTER LLC
Active
Organization
TEANECK RADIOLOGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HELENE G DEFURIA (ADMINISTRATOR)
(201) 836-2500
Entity
Organization
Contact information
Practice address
699 TEANECK ROAD, TEANECK, NJ 07666
(201) 836-2500
(201) 836-7921
Mailing address
P.O. BOX 609, EAST BRUNSWICK, NJ 08816
(732) 390-0040
(732) 390-1856
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
25MA04578500
NJ
261QR0200X
Radiology Clinic/Center
Primary
25MA04933000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014087
—
NJ
01
—
2K4160
HEALTHNET
NJ
01
—
4105356
GHI
NJ
01
—
8421710
AETNA
NJ
01
—
ANC395
OXFORD
NJ
Enumeration date
01/23/2007
Last updated
08/10/2012
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