Provider Demographics
NPI:1083234249
Name:ADVANCED MAGNETIC IMAGING
Entity Type:Organization
Organization Name:ADVANCED MAGNETIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAIFULLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-262-2909
Mailing Address - Street 1:6414 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1621
Mailing Address - Country:US
Mailing Address - Phone:201-295-1099
Mailing Address - Fax:201-295-1035
Practice Address - Street 1:6416 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1621
Practice Address - Country:US
Practice Address - Phone:201-295-1099
Practice Address - Fax:201-295-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-17
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22788OtherAMBULATORY CARE FACILITY