Provider Demographics
NPI:1073673174
Name:ROXBURY OPEN MRI AND SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:ROXBURY OPEN MRI AND SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-927-8100
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-0428
Mailing Address - Country:US
Mailing Address - Phone:973-927-8100
Mailing Address - Fax:
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:101
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1345
Practice Address - Country:US
Practice Address - Phone:973-927-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ026761Medicare PIN