Provider Demographics
NPI:1447372255
Name:ADVANCED INTERVENTIONAL RADIOLOGY SERVICES LLP
Entity type:Organization
Organization Name:ADVANCED INTERVENTIONAL RADIOLOGY SERVICES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNDBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-420-7070
Mailing Address - Street 1:PO BOX 17318
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-7318
Mailing Address - Country:US
Mailing Address - Phone:201-420-7070
Mailing Address - Fax:201-795-8629
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:RADIOLOGY DEPT-FLR 3
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-420-7070
Practice Address - Fax:201-795-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA079791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6299806Medicaid
NJ97447Medicare ID - Type Unspecified
NJ6299806Medicaid