1114911393 NPI number — CLIFTON MEDICAL IMAGING PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114911393 NPI number — CLIFTON MEDICAL IMAGING PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLIFTON MEDICAL IMAGING 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:
1114911393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1455 BROAD ST
Provider Second Line Business Mailing Address:
4TH FLOOR CLIFTON MEDICAL IMAGING PA
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003-3003
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:
1339 BROAD ST
Provider Second Line Business Practice Location Address:
CLIFTON MEDICAL IMAGING CENTER
Provider Business Practice Location Address City Name:
CLIFTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07013-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-778-9600
Provider Business Practice Location Address Fax Number:
973-778-4846
Provider Enumeration Date:
09/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEISEL
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-778-9600

Provider Taxonomy Codes

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

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

  • Identifier: 7423403 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com