1023064987 NPI number — NYDIC OPEN MRI OF AMERICA-MANHATTAN, LLC

Table of content: (NPI 1023064987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023064987 NPI number — NYDIC OPEN MRI OF AMERICA-MANHATTAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYDIC OPEN MRI OF AMERICA-MANHATTAN, LLC
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:
NYDIC-MANHATTAN
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:
1023064987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 YORK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10128-7807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-348-3900
Provider Business Mailing Address Fax Number:
212-348-3828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PARAGON DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MONTVALE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07645-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-573-8080
Provider Business Practice Location Address Fax Number:
201-775-4306
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHWALTER
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
201-573-8080

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4154853 . This is a "CIGNA PPO GROUP PROV NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ANC736 . This is a "OXFORD GROUP PROVIDER NO." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 592 . This is a "OXFORD-NYMI PROVIDER NO." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: XC1282 . This is a "HEALTHNET GROUP PROV NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4100608 . This is a "GHI GROUP PROVIDER NO." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WR6941 . This is a "EMPIRE HEALTHCHOICE GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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