Healthcare Provider Details

I. General information

NPI: 1417100892
Provider Name (Legal Business Name): MRI DIAGNOISTIC AND IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 INDEPENDENCE RD
EAST STROUDSBURG PA
18301-9447
US

IV. Provider business mailing address

230 INDEPENDENCE RD
EAST STROUDSBURG PA
18301-9447
US

V. Phone/Fax

Practice location:
  • Phone: 570-424-6300
  • Fax: 570-420-0746
Mailing address:
  • Phone: 570-424-6300
  • Fax: 570-420-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACI L BENJAMIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 570-420-0111