1659374684 NPI number — NYDIC OPEN MRI OF AMERICA-BOARDMAN

Table of content: (NPI 1659374684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659374684 NPI number — NYDIC OPEN MRI OF AMERICA-BOARDMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYDIC OPEN MRI OF AMERICA-BOARDMAN
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:
1659374684
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:
100 PARAGON DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
MONTVALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07645-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-573-8080
Provider Business Mailing Address Fax Number:
201-505-8905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1449 BOARDMAN CANFIELD RD
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
BOARDMAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-8070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-965-7370
Provider Business Practice Location Address Fax Number:
330-965-7377
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  0838-IC , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 175279 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 37524 . This is a "NATIONWIDE HEALTH PLANS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2433601 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5739664 . This is a "AETNA USHC ALL PLANS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1206654 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 21503 . This is a "MEDFOCUS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 16-01304 . This is a "UNITED HC OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34187720100 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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