Health Tech Diagnostic,LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA04275000 Issued in NJ

Legal business name

HEALTH TECH DIAGNOSTIC,LLC

Practice address

12 Krotik PL
Irvington, NJ 07111-1708

Phone

(908) 469-4771

Fax

(908) 327-9634

NPI assigned

Feb 26, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Willis Rudolph, M.D.

Title

Owner

Phone

(908) 469-4771

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393372800000",
    "number": "1326463449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 SPRINGFIELD RD",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072081534",
            "telephone_number": "908-469-4771",
            "fax_number": "908-327-9634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 KROTIK PL",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071111708",
            "telephone_number": "908-469-4771",
            "fax_number": "908-327-9634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH TECH DIAGNOSTIC,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-26",
        "last_updated": "2014-02-26",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "WILLIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-469-4771",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA04275000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0887307",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE  ID",
            "identifier": "526391",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Irvington, NJ
• Providers in Irvington, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.