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General NPI Number Information
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NPI Number | 1912238874
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Entity Type | Organization
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Legal Business Name | MYRON MEDICAL IMAGING, LLC
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 218 N 10TH ST
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City | KENILWORTH
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State | NJ
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Zip | 07033-1152
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Country | US
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Telephone | 973-207-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 218 N 10TH ST
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City | KENILWORTH
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State | NJ
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Zip | 07033-1152
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Country | US
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Telephone | 973-207-1828
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GEORGE BUABENG
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Credential |
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Telephone | 973-207-1828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 25MA04036000
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License Number State | NJ
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