Healthcare Provider Details

I. General information

NPI: 1023041340
Provider Name (Legal Business Name): MAHWAH RADIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRANKLIN TURNPIKE STE 202
MAHWAH NJ
07430
US

IV. Provider business mailing address

400 FRANKLIN TURNPIKE STE 202
MAHWAH NJ
07430
US

V. Phone/Fax

Practice location:
  • Phone: 201-236-3622
  • Fax: 201-236-3626
Mailing address:
  • Phone: 201-236-3622
  • Fax: 201-236-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: COREY WEINER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-236-3622