Healthcare Provider Details

I. General information

NPI: 1164967956
Provider Name (Legal Business Name): ENGELWOOD DIAGNOSTIC & IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N DEAN ST SUITE 202
ENGLEWOOD NJ
07631-2533
US

IV. Provider business mailing address

177 N DEAN ST SUITE 202
ENGLEWOOD NJ
07631-2533
US

V. Phone/Fax

Practice location:
  • Phone: 201-731-3507
  • Fax: 800-394-6163
Mailing address:
  • Phone: 201-731-3507
  • Fax: 201-731-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number24402
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number24402
License Number StateNJ

VIII. Authorized Official

Name: SONIA LASMIN
Title or Position: DIRECTOR
Credential:
Phone: 201-874-9084