Healthcare Provider Details

I. General information

NPI: 1447574660
Provider Name (Legal Business Name): MEDICAL & MOLECULAR IMAGING WAYNE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 HAMBURG TURNPIKE STE 8
WAYNE NJ
07470
US

IV. Provider business mailing address

22 MERIDIAN ROAD STE 7
EDISON NJ
08820
US

V. Phone/Fax

Practice location:
  • Phone: 973-720-0050
  • Fax: 973-720-0022
Mailing address:
  • Phone: 732-321-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: MS. HUMARA PARACHA
Title or Position: PRESIDENT
Credential:
Phone: 201-487-5300