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General NPI Number Information
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NPI Number | 1932125952
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF FAIRVIEW
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 178 BERGEN BLVD
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City | FAIRVIEW
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State | NJ
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Zip | 07022
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Country | US
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Telephone | 201-941-7575
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Fax | 201-941-1660
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Provider Business Mailing Address
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Address Line | 178 BERGEN BLVD PO BOX 99
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City | FAIRVIEW
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State | NJ
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Zip | 07022
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Country | US
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Telephone | 201-941-7575
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Fax | 201-941-1660
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LISA A GAGLIANO
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Credential | RT CXT
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Telephone | 201-941-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 22693
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License Number State | NJ
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