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General NPI Number Information
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NPI Number | 1144221771
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL IMAGING OF NORTH JERSEY, LLC
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 452 OLD HOOK RD SUITE 301
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City | EMERSON
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State | NJ
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Zip | 07630-1381
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Country | US
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Telephone | 201-262-0001
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Fax | 201-262-2330
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Provider Business Mailing Address
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Address Line | 452 OLD HOOK RD SUITE 301
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City | EMERSON
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State | NJ
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Zip | 07630-1381
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Country | US
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Telephone | 201-262-0001
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Fax | 201-262-2330
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MARK L. SHAPIRO
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Credential | MD
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Telephone | 201-262-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 23131
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License Number State | NJ
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