Healthcare Provider Details

I. General information

NPI: 1033466248
Provider Name (Legal Business Name): AMERICAN DIAGNOSTIC IMAGING OF NUTLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CENTRE ST
NUTLEY NJ
07110-1635
US

IV. Provider business mailing address

410 CENTRE ST
NUTLEY NJ
07110-1635
US

V. Phone/Fax

Practice location:
  • Phone: 973-661-2000
  • Fax: 973-661-1116
Mailing address:
  • Phone: 973-661-2000
  • Fax: 973-661-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number22787
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number22787
License Number StateNJ

VIII. Authorized Official

Name: MR. DANNY CHAUDHRY
Title or Position: PRESIDENT
Credential:
Phone: 973-661-2000