Organization
HEALTH TECH DIAGNOSTIC,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIS RUDOLPH M.D. (OWNER)
(908) 469-4771
Entity
Organization
Contact information
Practice address
12 KROTIK PL, IRVINGTON, NJ 07111-1708
(908) 469-4771
(908) 327-9634
Mailing address
207 SPRINGFIELD RD, ELIZABETH, NJ 07208-1534
(908) 469-4771
(908) 327-9634
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA04275000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0887307
—
NJ
01
—
526391
MEDICARE ID
NJ
Enumeration date
02/26/2014
Last updated
02/26/2014
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