1538356621 NPI number — CENTRAL JERSEY OPEN EXTREMITY MRI

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 1538356621 NPI number — CENTRAL JERSEY OPEN EXTREMITY MRI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL JERSEY OPEN EXTREMITY MRI
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:
Provider Other Organization Name Type Code:
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:
1538356621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 INDUSTRIAL WAY W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATONTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-2265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 INDUSTRIAL WAY W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
--
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PESS
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
732-542-4477

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com