Healthcare Provider Details

I. General information

NPI: 1932186608
Provider Name (Legal Business Name): OPEN MRI OF PERTH AMBOY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 NEW BRUNSWICK AVE
PERTH AMBOY NJ
08861-3658
US

IV. Provider business mailing address

PO BOX 3069
SOUTH AMBOY NJ
08879-3069
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-4240
  • Fax: 732-442-5404
Mailing address:
  • Phone: 732-721-5501
  • Fax: 732-721-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number22565
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number22565
License Number StateNJ

VIII. Authorized Official

Name: MS. IVETTE CUEVAS
Title or Position: FACILITY ADMINISTRATOR
Credential: RN
Phone: 732-721-5501