Organization
RADIOLOGY AND MEDICAL MANAGEMENT OF MILLBURN
Active
Other names
advanced diagnostic imaging of millburn
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN LOYOLA (CREDENTIALING OFFICER)
(973) 564-5858
Entity
Organization
Contact information
Practice address
25 E WILLOW ST, MILLBURN, NJ 07041-1416
(973) 564-5858
(973) 564-6382
Mailing address
25 E WILLOW ST, MILLBURN, NJ 07041-1416
(973) 564-5858
(973) 564-6386
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22904
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007207
FIRST HEALTH
NJ
01
—
2083813000
AMERIHEALTH HMO AND POS
NJ
01
—
2783932
AETNA HMO
NJ
01
—
2K0872
HEALTHNET
NJ
01
—
33783
UNIVERSITY HEALTH PLAN
NJ
01
—
7481363
AETNA PPO
NJ
05
—
8618607
—
NJ
Enumeration date
03/23/2007
Last updated
05/05/2008
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