Provider Demographics
NPI:1154725620
Name:OPTIMUM RADIOLOGY GROUP LLC
Entity type:Organization
Organization Name:OPTIMUM RADIOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-856-9800
Mailing Address - Street 1:714 RTE 35
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-4202
Mailing Address - Country:US
Mailing Address - Phone:732-856-9800
Mailing Address - Fax:
Practice Address - Street 1:714 RTE 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-4202
Practice Address - Country:US
Practice Address - Phone:732-856-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty