Provider Demographics
NPI:1033130240
Name:NORTHEAST OPEN MRI, INC
Entity Type:Organization
Organization Name:NORTHEAST OPEN MRI, INC
Other - Org Name:NORTHEAST OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-335-1100
Mailing Address - Street 1:9815 ROOSEVELT BOULEVARD
Mailing Address - Street 2:SUITE K
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114
Mailing Address - Country:US
Mailing Address - Phone:215-335-1100
Mailing Address - Fax:215-335-5370
Practice Address - Street 1:9815 ROOSEVELT BOULEVARD
Practice Address - Street 2:SUITE K
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-335-1100
Practice Address - Fax:215-335-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042193Medicare ID - Type Unspecified