1972689909 NPI number — PROGRESSIVE MEDICAL IMAGING OF UNION CITY, LLC

Table of content: (NPI 1972689909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972689909 NPI number — PROGRESSIVE MEDICAL IMAGING OF UNION CITY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE MEDICAL IMAGING OF UNION CITY, 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:
1972689909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 785956
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-541-5401
Provider Business Mailing Address Fax Number:
201-541-5400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3196 KENNEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-865-6100
Provider Business Practice Location Address Fax Number:
201-865-6102
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
201-541-5401

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  22927 , 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)





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