Provider Demographics
NPI:1124303987
Name:THE BREAST CENTER AT JOURNAL SQUARE, LLC
Entity type:Organization
Organization Name:THE BREAST CENTER AT JOURNAL SQUARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DINARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-721-6527
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-721-6527
Mailing Address - Fax:
Practice Address - Street 1:550 NEWARK AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1326
Practice Address - Country:US
Practice Address - Phone:201-721-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography