Provider Demographics
NPI:1275732034
Name:OPEN MRI OF WARREN LLLC
Entity Type:Organization
Organization Name:OPEN MRI OF WARREN LLLC
Other - Org Name:PROGRESSIVE DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:FESTANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-619-6294
Mailing Address - Street 1:44 ROUTE 23 NORTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-839-5004
Mailing Address - Fax:973-839-5006
Practice Address - Street 1:44 ROUTE 23 NORTH
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:973-839-5004
Practice Address - Fax:973-839-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology