Basic Information
| Provider Information | |||||||||
| NPI: | 1174010540 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE RADIOLOGY GROUP OF NEW JERSEY LLC | ||||||||
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| OtherOrganizationName: | THE MEDICAL GROUP OF NEW JERSEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 ROUTE 46 STE 212 | ||||||||
| Address2: | |||||||||
| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078402695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089791621 | ||||||||
| FaxNumber: | 9088509174 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 WILLOW GROVE ST | ||||||||
| Address2: | |||||||||
| City: | HACKETTSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078401799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089791621 | ||||||||
| FaxNumber: | 9088509174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2018 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | HINRICHS | ||||||||
| AuthorizedOfficialFirstName: | CLAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3271342997 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.