Provider Demographics
NPI:1982716361
Name:RIDGEFIELD IMAGING CENTER INC.
Entity type:Organization
Organization Name:RIDGEFIELD IMAGING CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-3410
Mailing Address - Street 1:669 BROAD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1637
Mailing Address - Country:US
Mailing Address - Phone:201-945-3410
Mailing Address - Fax:201-945-4438
Practice Address - Street 1:669 BROAD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1637
Practice Address - Country:US
Practice Address - Phone:201-945-3410
Practice Address - Fax:201-945-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22596261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7767501Medicaid
NJ22596OtherSTATE LICENSE
NJ7767501Medicaid