1295772572 NPI number — OPEN MRI OF MORRISTOWN JOINT VENTURE

Table of content: (NPI 1295772572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295772572 NPI number — OPEN MRI OF MORRISTOWN JOINT VENTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MRI OF MORRISTOWN JOINT VENTURE
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:
1295772572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE B04
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960-6092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-539-3373
Provider Business Mailing Address Fax Number:
973-539-7677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE B04
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07960-6092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-539-3373
Provider Business Practice Location Address Fax Number:
973-539-7677
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLYMER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
973-539-3373

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  23095 , 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: 3459900 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0123498 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com