Organization
968 RIVER ROAD RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT S PORT MD (CHAIRMAN OF RADIOLOGY)
(856) 616-8100
Entity
Organization
Contact information
Practice address
968 RIVER ROAD, EDGEWATER, NJ 07020
(856) 616-8100
(856) 616-1919
Mailing address
PO BOX 5075, CHERRY HILL, NJ 08034-5075
(856) 616-8100
(856) 616-1919
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017507
—
NJ
Enumeration date
07/03/2006
Last updated
08/22/2020
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