MEDICARE: NYDIC OPEN MRI OF AMERICA-BOARDMAN

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	0838-IC	OH
2	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	175279	OTHER	OH	UNISON
2	37524	OTHER	OH	NATIONWIDE HEALTH PLANS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5739664	OTHER	OH	AETNA USHC ALL PLANS
5	1206654	OTHER	OH	FIRST HEALTH NETWORK
6	21503	OTHER	OH	MEDFOCUS
7	16-01304	OTHER	OH	UNITED HC OF OHIO
8	34187720100	OTHER	OH	BWC

General Provider Information

NPI Number	:	1659374684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYDIC OPEN MRI OF AMERICA-BOARDMAN

Provider Business Mailing Address
First Line	:	100 PARAGON DR
Second Line	:	STE 200
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1718
Country	:	US
Telephone Number	:	201-573-8080
Fax Number	:	201-505-8905

Provider Business Practice Location Address
First Line	:	1449 BOARDMAN CANFIELD RD
Second Line	:	STE 140
City	:	BOARDMAN
State	:	OH
Zip	:	44512-8070
Country	:	US
Telephone Number	:	330-965-7370
Fax Number	:	330-965-7377

Authorized Official
Title or Position	:	CEO
Name	:	LAWRENCE M. BUCHWALTER
Credential	:
Telephone Number	:	201-573-8080

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/11/2025

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