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General NPI Number Information
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NPI Number | 1275732034
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF WARREN LLLC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 44 ROUTE 23 NORTH SUITE 100
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City | RIVERDALE
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State | NJ
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Zip | 07457
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Country | US
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Telephone | 973-839-5004
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Fax | 973-839-5006
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Provider Business Mailing Address
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Address Line | 44 ROUTE 23 NORTH SUITE 100
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City | RIVERDALE
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State | NJ
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Zip | 07457
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Country | US
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Telephone | 973-839-5004
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Fax | 973-839-5006
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MR. VINCENT FESTANTE
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Credential |
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Telephone | 570-619-6294
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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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