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General NPI Number Information
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NPI Number | 1437577368
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Entity Type | Organization
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Legal Business Name | ODI DIAGNOSTIC IMAGING OF NEWARK LLC
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 243 CHESTNUT ST 1ST FLOOR
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City | NEWARK
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State | NJ
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Zip | 07105-6501
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Country | US
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Telephone | 973-521-5685
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Fax | 862-237-7629
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Provider Business Mailing Address
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Address Line | 243 CHESTNUT ST 1ST FLOOR
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City | NEWARK
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State | NJ
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Zip | 07105-6501
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Country | US
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Telephone | 973-521-5685
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Fax | 862-237-7629
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Authorized Official
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Title or Position | OWNER
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Name | MR. SOLOMON ROTH
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Credential |
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Telephone | 973-521-5685
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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 | 23151
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License Number State | NJ
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