Healthcare Provider Details

I. General information

NPI: 1104704600
Provider Name (Legal Business Name): NORTH JERSEY MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CENTRE ST STE 1
NUTLEY NJ
07110-1635
US

IV. Provider business mailing address

410 CENTRE ST STE 1
NUTLEY NJ
07110-1635
US

V. Phone/Fax

Practice location:
  • Phone: 973-354-9700
  • Fax: 800-589-8370
Mailing address:
  • Phone: 973-354-9700
  • Fax: 800-589-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. WAHEED AHKBAR
Title or Position: MANAGING MEMBER
Credential:
Phone: 201-936-9947