NPIMap

Individual provider Active NPI

Kenneth M Nalaboff, MD

  • Diagnostic Radiology Physician
  • East Brunswick, NJ
National Provider Identifier
1417902883
Registry record updated Jul 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
25MA08388500 Issued in NJ
Practice address
483 Cranbury Rd
East Brunswick, NJ 08816
Phone
(732) 390-0030
Fax
(732) 390-1856
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 3, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 44640 WI
Diagnostic Radiology Physician 2085R0202X 47786 OH
Diagnostic Radiology Physician 2085R0202X 25MA08388500 NJ Primary

Addresses

Primary practice location

483 Cranbury Rd
East Brunswick, NJ 08816

Mailing address

579A Cranbury Rd
East Brunswick, NJ 08816
Phone (732) 390-0040

Other identifiers 4

IdentifierTypeStateIssuer
000000506347OtherOHANTHEM INDIVIDUAL
P00382665OtherOHRR MEDICARE-INDVIDUAL
2718572MedicaidOH
34296800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
47786OHMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Great Lakes Radiologists SC Diagnostic Radiology PastSince Apr 30, 2003 Accepting new patients
MRI & Imaging of Wisconsin Inc Diagnostic Radiology Past Accepting new patients
Hales Corners Imaging, LLC Past Accepting new patients
Hales Corners MRI, LLC Past Accepting new patients
Hillcrest Radiology Associates, Inc Diagnostic Radiology Past Accepting new patients
Wadsworth Imaging, Inc Diagnostic Radiology Past Accepting new patients
Lakes Radiology PLLC Diagnostic Radiology Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: knalaboff406997@hisp.ehr.sutterhealth.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215043200000",
    "number": "1417902883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "579A CRANBURY RD",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "08816",
            "telephone_number": "732-390-0040",
            "fax_number": "732-390-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 CRANBURY RD",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "08816",
            "telephone_number": "732-390-0030",
            "fax_number": "732-390-1856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NALABOFF",
        "first_name": "KENNETH",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2008-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "44640",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "47786",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA08388500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM INDIVIDUAL",
            "identifier": "000000506347",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE-INDVIDUAL",
            "identifier": "P00382665",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2718572",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34296800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Brunswick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; 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.