MEDICARE: ADVANCED IMAGING AND RADIOLOGY ASSOC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	23451	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134152457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED IMAGING AND RADIOLOGY ASSOC

Provider Business Mailing Address
First Line	:	1031 MCBRIDE AVE
Second Line	:	SUITE D 210
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2559
Country	:	US
Telephone Number	:	973-890-0037
Fax Number	:	973-256-1350

Provider Business Practice Location Address
First Line	:	1031 MCBRIDE AVE
Second Line	:	SUITE D 210
City	:	WEST PATERSON
State	:	NJ
Zip	:	07424-2559
Country	:	US
Telephone Number	:	973-890-0037
Fax Number	:	973-256-1350

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	COREY WEINER
Credential	:	MD
Telephone Number	:	973-890-0037

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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