MEDICARE: TILTON DYNAMIC IMAGING

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	23214	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	:	1265478747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TILTON DYNAMIC IMAGING

Provider Business Mailing Address
First Line	:	1226 TILTON RD
Second Line	:
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1809
Country	:	US
Telephone Number	:	609-383-2400
Fax Number	:	609-383-2407

Provider Business Practice Location Address
First Line	:	1226 TILTON RD
Second Line	:
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1809
Country	:	US
Telephone Number	:	609-383-2400
Fax Number	:	609-383-2407

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. NORMAN BRETTLER
Credential	:	MHA
Telephone Number	:	609-383-2400

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	08/22/2020

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