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General NPI Number Information
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NPI Number | 1124568910
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Entity Type | Organization
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Legal Business Name | EAST BRUNSWICK IMAGING CENTER LLC
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 647 ROUTE 18 SUITE W
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3747
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Country | US
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Telephone | 732-613-6300
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Fax | 732-613-6318
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Provider Business Mailing Address
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Address Line | 647 ROUTE 18 SUITE W
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3747
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Country | US
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Telephone | 732-613-6300
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Fax | 732-613-6318
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROMAN SHAPOSHNIKOV
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Credential |
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Telephone | 732-513-6300
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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 | 24450
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License Number State | NJ
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