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General NPI Number Information
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NPI Number | 1053780916
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Entity Type | Organization
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Legal Business Name | FAIRVIEW IMAGING CENTER INC
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 178 BERGEN BLVD
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1620
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Country | US
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Telephone | 201-313-3200
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Fax | 201-313-9700
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Provider Business Mailing Address
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Address Line | 178 BERGEN BLVD
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City | FAIRVIEW
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State | NJ
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Zip | 07022-1620
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Country | US
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Telephone | 201-313-3200
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Fax | 201-313-9700
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Authorized Official
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Title or Position | MANAGER
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Name | LAMA SALOUKHA
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Credential |
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Telephone | 201-313-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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