1104383363 NPI number — ASPIRIAN OPEN MRI OF SOUTHERN DELAWARE

Table of content: (NPI 1104383363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104383363 NPI number — ASPIRIAN OPEN MRI OF SOUTHERN DELAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRIAN OPEN MRI OF SOUTHERN DELAWARE
Provider Last Name:
Provider First Name:
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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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1104383363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34435 KING STREET ROW UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-4787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-644-7335
Provider Business Mailing Address Fax Number:
302-644-7336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34435 KING STREET ROW UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-4787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-7335
Provider Business Practice Location Address Fax Number:
302-644-7336
Provider Enumeration Date:
02/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
302-644-7335

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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