1003800277 NPI number — NORTHFIELD IMAGING CENTER PA

Table of content: (NPI 1003800277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003800277 NPI number — NORTHFIELD IMAGING CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHFIELD IMAGING CENTER PA
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:
6
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:
1003800277
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:
1455 BROAD STREET
Provider Second Line Business Mailing Address:
NORTHFIELD IMAGING CENTER PA 4TH FLOOR
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-873-9889
Provider Business Mailing Address Fax Number:
973-707-1127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
772 NORTHFIELD AVE
Provider Second Line Business Practice Location Address:
NORTHFIELD IMAGING CENTER
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-325-0002
Provider Business Practice Location Address Fax Number:
973-325-8140
Provider Enumeration Date:
09/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLOOM
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-236-0220

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5055407 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com