NPIMap

Organization Active NPI

Precious Life Medical Services LLC

  • Diagnostic Radiology Physician
  • Avenel, NJ
National Provider Identifier
1760058853
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PRECIOUS LIFE MEDICAL SERVICES LLC
Practice address
1030 Saint Georges Ave Ste 200a
Avenel, NJ 07001-1330
Phone
(732) 444-4646
NPI assigned
May 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Authorized official

Name
Fardose Rana, MSC, RDMS
Title
Owner
Phone
(732) 444-4646

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Physical Therapy Clinic/Center 261QP2000X
Primary Care Clinic/Center 261QP2300X
Pain Clinic/Center 261QP3300X

Addresses

Primary practice location

1030 Saint Georges Ave Ste 200a
Avenel, NJ 07001-1330

Mailing address

1030 Saint Georges Ave Ste 200a
Avenel, NJ 07001-1330
Phone (732) 444-4646

Other identifiers 1

IdentifierTypeStateIssuer
0886432MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1622419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1760058853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 SAINT GEORGES AVE STE 200A",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011330",
            "telephone_number": "732-444-4646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 SAINT GEORGES AVE STE 200A",
            "city": "AVENEL",
            "state": "NJ",
            "postal_code": "070011330",
            "telephone_number": "732-444-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRECIOUS LIFE MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-31",
        "last_updated": "2023-02-01",
        "certification_date": "2022-10-27",
        "status": "A",
        "authorized_official_last_name": "RANA",
        "authorized_official_first_name": "FARDOSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-444-4646",
        "authorized_official_credential": "MSC, RDMS"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0886432",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Avenel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; 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.