Provider Demographics
NPI:1225380066
Name:MARINA IDTF OF NJ INC.
Entity Type:Organization
Organization Name:MARINA IDTF OF NJ INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-927-6859
Mailing Address - Street 1:251 E 5TH ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 ROUTE 17
Practice Address - Street 2:SUITE 800
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2575
Practice Address - Country:US
Practice Address - Phone:347-927-6859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile