GARDEN STATE MRI CORP (NPI# 1497700702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497700702 |
| Entity Type | Organization |
| Organization Name | GARDEN STATE MRI CORP |
| Other Organization Name | EASTLANTIC DIAGNOSTIC INSTITUTE |
| Practice Address |
1470 S Main Rd Building 2 Vineland NJ 08360-6588 |
| Mailing Address |
Po Box 1444 Vineland NJ 08362-1444 |
| Practice Telephone | 8566900300 |
| Practice Fax Number | 8562059925 |
| Mailing Telephone | 8567942337 |
| Mailing Fax Number | 8562059925 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2008-03-11 |
| Authorized Official Name | DR. RALPH DAUITO (CEO) |
| Authorized Official Telephone | 8567942337 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
25MA05144800 | NJ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 1528301 | 05 | |
| AMERICHOICE | 0-1000769500 | 01 | |
| AMERIGROUP | 40184 | 01 | |
| OXFORD | ANC929 | 01 | |
| AMERIHEALTH | 0-401564000 | 01 | |
| NJ | MEDICAR E GROUP NUMBER | 101191 | 01 |
| HORIZON NJ HEALTH | 1025244 | 01 | |
| AETNA | 1333467 | 01 | |
| CIGNA | 0-49332 | 01 | |
| UNITED HEALTHCARE | 1276753 | 01 |
| Other Name | Type Code |
|---|---|
| eastlantic diagnostic institute | Doing Business As Name - Organization |
| Street Address |
1470 S MAIN RD BUILDING 2 |
| City | VINELAND |
| State | NJ |
| Zip Code | 08360-6588 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215534748 | Lindsay Gibbons | Social Worker | 60 W Ave, Vineland, NJ 08360 | 2020-10-07 |
| 1033769849 | Buena Vista Township Emergency Medical Services Inc. | Ambulance | 4931 E. Landis Ave., Vineland, NJ 08360 | 2019-09-13 |
| 1669037636 | Elwyn New Jersey | Day Training, Developmentally Disabled Services | Elwyn New Jersey Supported Employment Small Group, 228 W. Landis Avenue, Suite 302, Vineland, NJ 08360 | 2019-05-06 |
| 1972001519 | Kyle James Knowles | Physician Assistant | 1138 East Chestnut Avenue, Building 8 Suite B, Vineland, NJ 08360 | 2018-01-29 |
| 1205346574 | Maryville, Inc | Clinic/Center | 1173 E Landis Ave, Vineland, NJ 08360 | 2017-10-02 |
| 1184147043 | Sarah Lee | Pharmacist | 75 W Landis Ave, Vineland, NJ 08360 | 2017-07-24 |
| 1780111419 | Elwyn New Jersey | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 30 D'shibe Terrace, Vineland, NJ 08360 | 2017-05-12 |
| 1528414810 | Khushbu V Janani | Internal Medicine | 1505 W Sherman Avenue, Inspira Health Network, Vineland, NJ 08360 | 2016-05-05 |
| 1669841409 | University Womens Imaging LLC | Clinic/Center | 1051 West Sherman Avenue, Suite 4a, Vineland, NJ 08360 | 2015-09-23 |
| 1710369350 | Elwyn New Jersey | Day Training, Developmentally Disabled Services | 46 N West Ave, Building A, Vineland, NJ 08360 | 2015-06-19 |
| Find all providers in zip 08360 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245559194 | Eric Wydra | Radiology | 1505 W. Sherman Avenue, Dept of Radiology, Vineland, NJ 08360-6912 | 2010-05-18 |
| 1902051402 | Vineland Mri PC | Radiology | 2848 S Delsea Dr, Vineland, NJ 08360-7042 | 2008-11-25 |
| 1902014749 | Nitesh N Bhagat | Radiology | 1505 W Sherman Ave, Vineland, NJ 08360-6912 | 2007-05-17 |
| 1407868201 | University Imaging Center LLC | Radiology | 1051 W Sherman Ave, Ste 2b, Vineland, NJ 08360-6931 | 2006-08-12 |
| 1598795932 | Bridget D Bernardi | Radiology | 1505 W Sherman Ave, Vineland, NJ 08360-6912 | 2006-07-03 |
| 1285675389 | Jacqueline S Gomberg | Radiology | 1505 W Sherman Ave, Vineland, NJ 08360-6912 | 2006-06-09 |
| 1730129826 | Satish P Shah | Radiology | 1450 E Chestnut Ave, Building 4, Suite A, Vineland, NJ 08361-8467 | 2006-06-07 |
| 1285674358 | Steven H Rothfarb | Radiology | 1450 E Chestnut Ave, Building 4, Suite A, Vineland, NJ 08361-8467 | 2006-06-07 |
| 1073553152 | Shailendra A Desai | Radiology | 1450 E Chestnut Ave, Building 4, Suite A, Vineland, NJ 08361-8467 | 2006-06-07 |
| 1265489207 | Ernesto B Go | Radiology | 1450 E Chestnut Ave, Building 4, Suite A, Vineland, NJ 08361-8467 | 2006-05-27 |
| Find all providers in VINELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.