Healthcare Provider Details

I. General information

NPI: 1962499772
Provider Name (Legal Business Name): MAGNETIC IMAGING OF MORRIS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 BLVD SUITE 103
MTN LAKES NJ
07046
US

IV. Provider business mailing address

420 BLVD SUITE 103
MTN LAKES NJ
07046
US

V. Phone/Fax

Practice location:
  • Phone: 973-402-9111
  • Fax: 973-402-7620
Mailing address:
  • Phone: 973-402-9111
  • Fax: 973-402-7620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number23244
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number23244
License Number StateNJ

VIII. Authorized Official

Name: JEFFREY DUNN
Title or Position: MANAGER
Credential:
Phone: 973-402-9111