1093867202 NPI number — STAR OPEN MRI, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093867202 NPI number — STAR OPEN MRI, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAR OPEN MRI, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED RADIOLOGY & CARDIOVASCULAR CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093867202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3729 EASTON NAZARETH HWY
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18045-8344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-559-0300
Provider Business Mailing Address Fax Number:
610-559-1324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3729 EASTON NAZARETH HWY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18045-8344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-559-0300
Provider Business Practice Location Address Fax Number:
610-559-1324
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AMIN
Authorized Official First Name:
ATUL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-559-0300

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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