1700942208 NPI number — ATLANTIC OPEN MRI, LLC

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 1700942208 NPI number — ATLANTIC OPEN MRI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC OPEN MRI, LLC
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:
1700942208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
766 SHREWSBURY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINTON FALLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-3001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-530-8989
Provider Business Mailing Address Fax Number:
732-530-0420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
766 SHREWSBURY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINTON FALLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-530-8989
Provider Business Practice Location Address Fax Number:
732-530-0420
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIBBENS
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
732-530-8989

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  22368 , 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: 2K6430 . This is a "HEALTHNET PIN#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1839680 . This is a "UNITEDHEALTHCARE PIN#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8211302 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1130240V . This is a "NJ HORIZON MERCY PIN#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2098369000 . This is a "AMERIHEALTH PIN#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4103497 . This is a "GHI PIN#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 28090922 . This is a "AETNA PIN#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A959624 . This is a "OXFORD PIN#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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