Provider Demographics
NPI:1376417659
Name:GOODLAND MEDICAL DIAGNOSTIC SERVICES
Entity type:Organization
Organization Name:GOODLAND MEDICAL DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMOBUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ITUA
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:732-910-2894
Mailing Address - Street 1:4 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1679
Mailing Address - Country:US
Mailing Address - Phone:732-910-2894
Mailing Address - Fax:
Practice Address - Street 1:4 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1679
Practice Address - Country:US
Practice Address - Phone:732-910-2894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODLAND TLC HOME HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty