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General NPI Number Information
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NPI Number | 1164967956
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Entity Type | Organization
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Legal Business Name | ENGELWOOD DIAGNOSTIC & IMAGING CENTER LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 177 N DEAN ST SUITE 202
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2533
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Country | US
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Telephone | 201-731-3507
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Fax | 800-394-6163
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Provider Business Mailing Address
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Address Line | 177 N DEAN ST SUITE 202
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2533
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Country | US
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Telephone | 201-731-3507
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Fax | 201-731-3056
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Authorized Official
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Title or Position | DIRECTOR
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Name | SONIA LASMIN
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Credential |
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Telephone | 201-874-9084
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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 | 24402
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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 | 24402
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License Number State | NJ
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