Organization
ADVANCED RADIOLOGY OF MILLVILLE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FAZLOLLAH GOLESTANEH MD (PRESIDENT)
(856) 293-1632
Entity
Organization
Contact information
Practice address
1001 N HIGH STREET, MILLVILLE, NJ 08332
(856) 825-0005
(856) 825-5576
Mailing address
PO BOX 2300, SO VINELAND, NJ 08362-2300
(856) 293-1632
(856) 293-7810
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA03109900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5390702
—
NJ
Enumeration date
12/14/2006
Last updated
08/22/2020
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