Healthcare Provider Details

I. General information

NPI: 1770596421
Provider Name (Legal Business Name): HACKENSACK MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 STATE ST
HACKENSACK NJ
07601-5419
US

IV. Provider business mailing address

155 STATE ST
HACKENSACK NJ
07601-5419
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-5300
  • Fax: 201-487-5378
Mailing address:
  • Phone: 201-487-5300
  • Fax: 201-487-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number23128
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MISS FAIZAH ZUBERI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-487-5300