Provider Demographics
NPI:1003800277
Name:NORTHFIELD IMAGING CENTER PA
Entity Type:Organization
Organization Name:NORTHFIELD IMAGING CENTER PA
Other - Org Name:NORTHFIELD IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-236-0220
Mailing Address - Street 1:1455 BROAD STREET
Mailing Address - Street 2:NORTHFIELD IMAGING CENTER PA 4TH FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-873-9889
Mailing Address - Fax:973-707-1127
Practice Address - Street 1:772 NORTHFIELD AVE
Practice Address - Street 2:NORTHFIELD IMAGING CENTER
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-325-0002
Practice Address - Fax:973-325-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5055407Medicaid
NJ700152C33Medicare ID - Type Unspecified