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General NPI Number Information
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NPI Number | 1740341049
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Entity Type | Organization
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Legal Business Name | MAIN MEDICAL IMAGING CENTER
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1003 MAIN AVE # 1011
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City | CLIFTON
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State | NJ
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Zip | 07011-2333
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Country | US
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Telephone | 973-777-6661
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Fax | 973-777-1311
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Provider Business Mailing Address
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Address Line | 1003 MAIN AVE # 1011
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City | CLIFTON
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State | NJ
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Zip | 07011-2333
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Country | US
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Telephone | 973-777-6661
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Fax | 973-777-1311
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MANSOUR SAQFELHAIT
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Credential |
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Telephone | 973-777-6661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MA044755
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License Number State | NJ
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