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General NPI Number Information
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NPI Number | 1003872953
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Entity Type | Organization
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Legal Business Name | MRI OF WOODBRIDGE LLC
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 1500 SAINT GEORGES AVE
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City | AVENEL
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State | NJ
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Zip | 07001-1000
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Country | US
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Telephone | 732-574-0742
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Fax | 732-574-0143
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Provider Business Mailing Address
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Address Line | PO BOX 828393
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City | PHILADELPHIA
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State | PA
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Zip | 19182-8393
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Country | US
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Telephone | 732-381-8686
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Fax | 732-499-7724
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LEO FONTANA
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Credential | M.D.
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Telephone | 732-574-0742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | 22624
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 22624
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License Number State | NJ
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