1831192855 NPI number — OPEN MRI OF NORTHERN ILLINOIS, L.L.C.

Table of content: (NPI 1831192855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192855 NPI number — OPEN MRI OF NORTHERN ILLINOIS, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MRI OF NORTHERN ILLINOIS, L.L.C.
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 OPEN MRI OF AMERICA-BUFFALO GROVE
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:
1831192855
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:
2150 E LAKE COOK RD
Provider Second Line Business Practice Location Address:
STE 40C
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-8220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-465-3500
Provider Business Practice Location Address Fax Number:
847-465-3510
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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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