Provider Demographics
NPI:1124034764
Name:ADVANCED IMAGING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-823-8999
Mailing Address - Street 1:190 MUNSONHURST RD
Mailing Address - Street 2:STERLING PLAZA
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-1814
Mailing Address - Country:US
Mailing Address - Phone:973-823-8999
Mailing Address - Fax:973-823-8989
Practice Address - Street 1:190 MUNSONHURST RD
Practice Address - Street 2:STERLING PLAZA
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-1814
Practice Address - Country:US
Practice Address - Phone:973-823-8999
Practice Address - Fax:973-823-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207U00000X, 2085N0700X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8740208Medicaid
NJ049502Medicare PIN