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General NPI Number Information
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NPI Number | 1609879634
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF BOISE, L.LC.
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7979 W RIFLEMAN ST STE 100
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City | BOISE
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State | ID
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Zip | 83704-9066
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Country | US
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Telephone | 208-375-6133
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Fax | 208-375-6461
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Provider Business Mailing Address
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Address Line | 100 PARAGON DR STE 200
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City | MONTVALE
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State | NJ
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Zip | 07645-1718
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Country | US
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Telephone | 201-573-8080
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Fax | 201-505-8905
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Authorized Official
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Title or Position | CEO
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Name | LAWRENCE M. BUCHWALTER
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Credential |
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Telephone | 201-573-8080
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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 |
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License Number State |
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