Provider Demographics
NPI:1023034063
Name:HOBOKEN MRI, P.A.
Entity Type:Organization
Organization Name:HOBOKEN MRI, P.A.
Other - Org Name:HOBOKEN MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-418-0040
Mailing Address - Street 1:2 HUDSON PL
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5594
Mailing Address - Country:US
Mailing Address - Phone:201-418-0040
Mailing Address - Fax:201-418-8510
Practice Address - Street 1:2 HUDSON PL
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5594
Practice Address - Country:US
Practice Address - Phone:201-418-0040
Practice Address - Fax:201-418-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22536261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6903401Medicaid
NJ861829Medicare ID - Type UnspecifiedMEDICARE NUMBER