Healthcare Provider Details

I. General information

NPI: 1134152457
Provider Name (Legal Business Name): ADVANCED IMAGING AND RADIOLOGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 MCBRIDE AVE SUITE D 210
WEST PATERSON NJ
07424-2559
US

IV. Provider business mailing address

1031 MCBRIDE AVE SUITE D 210
WEST PATERSON NJ
07424-2559
US

V. Phone/Fax

Practice location:
  • Phone: 973-890-0037
  • Fax: 973-256-1350
Mailing address:
  • Phone: 973-890-0037
  • Fax: 973-256-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23451
License Number StateNJ

VIII. Authorized Official

Name: COREY WEINER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 973-890-0037