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General NPI Number Information
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NPI Number | 1932186608
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF PERTH AMBOY, LLC
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Dates
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Enumeration Date | 12/23/2005
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 551 NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3658
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Country | US
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Telephone | 732-442-4240
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Fax | 732-442-5404
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Provider Business Mailing Address
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Address Line | PO BOX 3069
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City | SOUTH AMBOY
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State | NJ
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Zip | 08879-3069
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Country | US
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Telephone | 732-721-5501
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Fax | 732-721-7890
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | MS. IVETTE CUEVAS
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Credential | RN
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Telephone | 732-721-5501
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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 | 22565
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 22565
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License Number State | NJ
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