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General NPI Number Information
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NPI Number | 1245814623
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Entity Type | Organization
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Legal Business Name | PASSAIC IMAGING ASSOCIATES LLC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 350 BOULEVARD
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City | PASSAIC
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State | NJ
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Zip | 07055-2840
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Country | US
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Telephone | 973-365-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 45 PINE ST STE 8
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City | ROCKAWAY
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State | NJ
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Zip | 07866-3149
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Country | US
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Telephone | 973-627-7922
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Fax | 973-627-5957
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEIL FREEMAN
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Credential | MD
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Telephone | 973-769-6525
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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 |
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License Number State |
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