1700942208 NPI number — ATLANTIC OPEN MRI, LLC

Table of content: (NPI 1700942208)

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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