Basic Information
| Provider Information | |||||||||
| NPI: | 1699090381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HACKETTSTOWN IMAGING SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 CHILTON RD | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079303109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089791621 | ||||||||
| FaxNumber: | 9089791622 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 CHILTON RD | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079303109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089791621 | ||||||||
| FaxNumber: | 9089791622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 04/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | HINRICHS | ||||||||
| AuthorizedOfficialFirstName: | CLAY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9089791621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.