Provider Demographics
NPI:1386864635
Name:OPEN MRI & IMAGING OF NEWARK
Entity Type:Organization
Organization Name:OPEN MRI & IMAGING OF NEWARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENEDETTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-274-0200
Mailing Address - Street 1:243 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-6501
Mailing Address - Country:US
Mailing Address - Phone:973-274-0200
Mailing Address - Fax:973-274-0220
Practice Address - Street 1:243 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-6501
Practice Address - Country:US
Practice Address - Phone:973-274-0200
Practice Address - Fax:973-274-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ224792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0122068Medicaid
NJ031242Medicare PIN