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General NPI Number Information
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NPI Number | 1356318760
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Entity Type | Organization
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Legal Business Name | ADVANCED MAGNETIC IMAGING
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 6416 BERGENLINE AVENUE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093
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Country | US
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Telephone | 201-295-1099
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Fax | 201-295-1035
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Provider Business Mailing Address
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Address Line | 6416 BERGENLINE AVENUE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093
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Country | US
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Telephone | 201-295-1099
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Fax | 201-295-1035
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Authorized Official
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Title or Position | CREDENTIALING
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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 | 22788
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 22788
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License Number State | NJ
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