Healthcare Provider Details

I. General information

NPI: 1770519423
Provider Name (Legal Business Name): OPEN MRI OF UNION COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ELMORA AVE STE 200
ELIZABETH NJ
07208-1383
US

IV. Provider business mailing address

315 ELMORA AVE STE 200
ELIZABETH NJ
07208-1383
US

V. Phone/Fax

Practice location:
  • Phone: 908-282-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK WEISBERG
Title or Position: OWNER
Credential:
Phone: 908-282-1100