Provider Demographics
NPI:1396905923
Name:GARDEN STATE MOLECULAR IMAGING INC
Entity type:Organization
Organization Name:GARDEN STATE MOLECULAR IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAZISH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-581-2727
Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:STE 403
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:STE 403
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3831
Practice Address - Country:US
Practice Address - Phone:609-581-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty