Organization
ENGLEWOOD IMAGING CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK LAWRENCE BALDASSARE MD (MEDICAL DIRECTTOR)
(201) 567-6156
Entity
Organization
Contact information
Practice address
220 OXFORD DR, TENAFLY, NJ 07670-3118
(201) 567-6156
(201) 871-8708
Mailing address
220 OXFORD DR, TENAFLY, NJ 07670-3118
(201) 567-6156
(201) 871-8708
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2956900
—
NJ
Enumeration date
06/11/2006
Last updated
04/30/2010
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