Healthcare Provider Details

I. General information

NPI: 1164466926
Provider Name (Legal Business Name): MEDICAL IMAGING OF TEANECK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 PALISADE AVE SUITE 305
TEANECK NJ
07666-3419
US

IV. Provider business mailing address

870 PALISADE AVE SUITE 305
TEANECK NJ
07666-3419
US

V. Phone/Fax

Practice location:
  • Phone: 201-836-2509
  • Fax: 201-836-2517
Mailing address:
  • Phone: 201-836-2509
  • Fax: 201-836-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number24115
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number24115
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number24115
License Number StateNJ

VIII. Authorized Official

Name: MRS. BRENDA L CONCEPCION
Title or Position: CREDENTIALING SPEACIALIST
Credential:
Phone: 201-836-2509