Provider Demographics
NPI:1144221771
Name:ADVANCED MEDICAL IMAGING OF NORTH JERSEY, LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL IMAGING OF NORTH JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-262-0001
Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1381
Mailing Address - Country:US
Mailing Address - Phone:201-262-0001
Mailing Address - Fax:201-262-2330
Practice Address - Street 1:452 OLD HOOK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1381
Practice Address - Country:US
Practice Address - Phone:201-262-0001
Practice Address - Fax:201-262-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ231312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS75304OtherAIM
NJ2K3550OtherHEALTHNET
NJA2945029OtherOXFORD
NJDA3186OtherRAILROAD MEDICARE
NJS20Y21OtherBLUE CROSS BLUE SHIELD
NJ2173755000OtherAMERIHEALTH
NJ2173755000OtherAMERIHEALTH