Healthcare Provider Details

I. General information

NPI: 1255613022
Provider Name (Legal Business Name): AMERICAN IMAGING OF WEST ORANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 STATE ST
HACKENSACK NJ
07601-5419
US

IV. Provider business mailing address

PO BOX 493
HACKENSACK NJ
07602-0493
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-1100
  • Fax: 732-321-1150
Mailing address:
  • Phone: 732-321-1100
  • Fax: 732-321-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number24342
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FAISAL PARACHA
Title or Position: SOLE MBR
Credential:
Phone: 732-321-1100