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General NPI Number Information
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NPI Number | 1558429019
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Entity Type | Organization
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Legal Business Name | GARDEN STATE OPEN MRI DIAGNOSTIC CENTER INC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 05/08/2017
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Provider Practice Location Address
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Address Line | 831 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-8400
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Country | US
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Telephone | 973-614-9400
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Fax | 973-614-9441
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Provider Business Mailing Address
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Address Line | 831 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-8400
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Country | US
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Telephone | 973-614-9400
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Fax | 973-614-9441
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Authorized Official
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Title or Position | OWNER
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Name | MR. ABDUR RAHMAN
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Credential |
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Telephone | 973-614-9400
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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 | 261QM1200X
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License Number State | NJ
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