Provider Demographics
NPI:1164466926
Name:MEDICAL IMAGING OF TEANECK INC.
Entity Type:Organization
Organization Name:MEDICAL IMAGING OF TEANECK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPEACIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-836-2509
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-836-2509
Mailing Address - Fax:201-836-2517
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-836-2509
Practice Address - Fax:201-836-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24115261QR0200X, 261QR0206X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Not Answered261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF42456Medicare UPIN
NJC58863Medicare UPIN
NJ404424Medicare ID - Type UnspecifiedHENRY NOTARDONATO
NJH01799Medicare UPIN
NJ128942Medicare ID - Type UnspecifiedGAIL QUACKENBUSH
NJ072121Medicare ID - Type UnspecifiedSTANTON KOFSKY
NJF84894Medicare UPIN
NJ067116Medicare ID - Type UnspecifiedRADIOLOGY GRP
NJF62222Medicare UPIN
NJ563729Medicare ID - Type UnspecifiedTERRANCE LEE
NJE23849Medicare UPIN
NJ030470Medicare ID - Type UnspecifiedJOSEPH D INZINNA