Healthcare Provider Details

I. General information

NPI: 1083834584
Provider Name (Legal Business Name): PASCACK VALLEY IMAGING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 OLD HOOK RD
WESTWOOD NJ
07675-3117
US

IV. Provider business mailing address

645 WESTWOOD AVE 2ND FLOOR
RIVERVALE NJ
07675-6238
US

V. Phone/Fax

Practice location:
  • Phone: 201-358-6774
  • Fax: 201-358-1140
Mailing address:
  • Phone: 201-358-6774
  • Fax: 201-358-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STAN SMORRA
Title or Position: FACILITY MANAGER
Credential:
Phone: 201-358-6774