Radiology and Medical Management of Millburn

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

22904 Issued in NJ

Legal business name

RADIOLOGY AND MEDICAL MANAGEMENT OF MILLBURN

Doing business as

advanced diagnostic imaging of millburn

Practice address

25 E Willow St
Millburn, NJ 07041-1416

Phone

(973) 564-5858

Fax

(973) 564-6382

NPI assigned

Mar 23, 2007

Last updated

May 5, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kathleen Loyola

Title

Credentialing Officer

Phone

(973) 564-5858

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• advanced diagnostic imaging of millburn Doing business as

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1548387863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 E WILLOW ST",
            "city": "MILLBURN",
            "state": "NJ",
            "postal_code": "070411416",
            "telephone_number": "973-564-5858",
            "fax_number": "973-564-6386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 E WILLOW ST",
            "city": "MILLBURN",
            "state": "NJ",
            "postal_code": "070411416",
            "telephone_number": "973-564-5858",
            "fax_number": "973-564-6382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY AND MEDICAL MANAGEMENT OF MILLBURN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "LOYOLA",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CREDENTIALING OFFICER",
        "authorized_official_telephone_number": "973-564-5858",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "22904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH HMO AND POS",
            "identifier": "2083813000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY HEALTH PLAN",
            "identifier": "33783",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "2783932",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2K0872",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "2007207",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7481363",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8618607",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "advanced diagnostic imaging of millburn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Diagnostic Radiology Physician in Millburn, NJ
• Providers in Millburn, NJ by specialty
• Diagnostic Radiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.