Organization
STAT RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MINDY BETETA (ASSISTANT ADMINISTRATOR)
(732) 364-6004
Entity
Organization
Contact information
Practice address
1166 RIVER AVE, SUITE 102, LAKEWOOD, NJ 08701-5600
(732) 364-6004
(732) 364-1908
Mailing address
1166 RIVER AVE, SUITE 102, LAKEWOOD, NJ 08701-5600
(732) 364-6004
(732) 364-1908
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH4391
RAILROAD MEDICARE
NJ
Enumeration date
07/19/2007
Last updated
07/16/2008
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