Healthcare Provider Details

I. General information

NPI: 1720164734
Provider Name (Legal Business Name): PROGRESSIVE MEDICAL IMAGING OF HACKENSACK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 PROSPECT AVE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

PO BOX 785961
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-4808
  • Fax: 201-488-9558
Mailing address:
  • Phone: 201-541-5401
  • Fax: 201-541-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number23025
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ARTHUR S. WEISEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 201-444-5945