Provider Demographics
NPI:1346311941
Name:ENGLEWOOD IMAGING ASSOCIATES, PA
Entity Type:Organization
Organization Name:ENGLEWOOD IMAGING ASSOCIATES, PA
Other - Org Name:OPEN MRI AT NORTHEAST IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-952-5717
Mailing Address - Street 1:PO BOX 12295
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0880
Mailing Address - Country:US
Mailing Address - Phone:201-222-9020
Mailing Address - Fax:201-222-9040
Practice Address - Street 1:606 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2307
Practice Address - Country:US
Practice Address - Phone:201-222-9020
Practice Address - Fax:201-222-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2956900Medicaid
NJ443031Medicare ID - Type Unspecified