MEDICARE: NYDIC OPEN MRI OF AMERICA-MAHWAH VALLEY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	22517	NJ
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4196850	OTHER	NJ	GHI
2	1440067	OTHER	NJ	UNITED HEALTHCARE OF NJ
3	WS5721	OTHER	NJ	WELLCHOICE
4	22160	OTHER	NJ	MEDFOCUS
5	3082416	OTHER	NJ	CIGNA PPO
6	22911	OTHER	NJ	UNIVERSITY HEALTH PLAN
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	2K1317	OTHER	NJ	HEALTHNET
9	5922493	OTHER	NJ	AETNA NON-HMO
10	A463305	OTHER	NJ	OXFORD
11	1078395	OTHER	NJ	FIRST HEALTH NETWORK
12	2819104	OTHER	NJ	AETNA HMO
13	37574	OTHER	NJ	AMERICAID AMERIGROUP

General Provider Information

NPI Number	:	1649232455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYDIC OPEN MRI OF AMERICA-MAHWAH VALLEY, LLC

Provider Business Mailing Address
First Line	:	100 PARAGON DR
Second Line	:	SUITE 200
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1718
Country	:	US
Telephone Number	:	201-573-8080
Fax Number	:	201-775-4306

Provider Business Practice Location Address
First Line	:	400 FRANKLIN TPKE
Second Line	:	SUITE B
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3516
Country	:	US
Telephone Number	:	201-760-9500
Fax Number	:	201-760-0295

Authorized Official
Title or Position	:	CEO
Name	:	MR. LAWRENCE M. BUCHWALTER
Credential	:
Telephone Number	:	201-573-8080

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	09/11/2025

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