Healthcare Provider Details

I. General information

NPI: 1679579775
Provider Name (Legal Business Name): DELAWARE OPEN MRI RADIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H 42 OMEGA DRIVE
NEWARK DE
19713
US

IV. Provider business mailing address

101 GREENWOOD AVENUE SUITE 150
JENKINTOWN PA
19046
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-1700
  • Fax: 302-738-0100
Mailing address:
  • Phone: 215-663-5910
  • Fax: 215-663-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA KASSA
Title or Position: VP OF OPERATIONS
Credential:
Phone: 904-515-0362