NPIMap

Organization Active NPI

Coral Diagnostics, LLC

  • Mobile Radiology Clinic/Center
  • Paterson, NJ
National Provider Identifier
1457593196
Registry record updated May 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X
License
25MB07597800 Issued in NJ
Legal business name
CORAL DIAGNOSTICS, LLC
Practice address
684 Market St
Paterson, NJ 07513-1231
Phone
(917) 257-7227
Fax
(973) 807-1613
NPI assigned
Mar 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2009

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

Authorized official

Name
Dr. Manjushree Matadial, DO
Title
MD
Phone
(917) 257-7227

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X 25MB07597800 NJ
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 25MB07597800 NJ
Mobile Radiology Clinic/Center 261QR0208X 25MB07597800 NJ Primary

Addresses

Primary practice location

684 Market St
Paterson, NJ 07513-1231

Mailing address

PO Box 3042
Clifton, NJ 07012-0342
Phone (973) 779-7354

Other identifiers 2

IdentifierTypeStateIssuer
0044377MedicaidNJ
25MB07597800OtherNJSTATE LICENSE

National Provider Directory

National Provider Directory

Locations

1272 Clifton Ave
Clifton, NJ 07012
Phone (908) 209-7081

636 Bayway Ave
Elizabeth, NJ 07202
Phone (908) 994-1900

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1238025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243382400000",
    "number": "1457593196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3042",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070120342",
            "telephone_number": "973-779-7354",
            "fax_number": "973-779-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 MARKET ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075131231",
            "telephone_number": "917-257-7227",
            "fax_number": "973-807-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAL DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-26",
        "last_updated": "2009-05-27",
        "status": "A",
        "authorized_official_last_name": "MATADIAL",
        "authorized_official_first_name": "MANJUSHREE",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "917-257-7227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MB07597800",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB07597800",
            "primary": false
        },
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": "NJ",
            "license": "25MB07597800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0044377",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "25MB07597800",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paterson, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; 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.