1699737486 NPI number — NYDIC OPEN MRI OF AMERICA-LAFAYETTE, LLC

Table of content: (NPI 1699737486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699737486 NPI number — NYDIC OPEN MRI OF AMERICA-LAFAYETTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYDIC OPEN MRI OF AMERICA-LAFAYETTE, 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:
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:
1699737486
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:
SUITE 100
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:
201-775-4306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 GUILBEAU RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-8405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-984-0002
Provider Business Practice Location Address Fax Number:
337-984-0003
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHWALTER
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
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: "X" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 21500 . This is a "MEDFOCUS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1236965 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1949515 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1600912 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: A-91984 . This is a "MULTIPLAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com