Provider Demographics
NPI:1417100892
Name:MRI DIAGNOISTIC AND IMAGING CENTER
Entity Type:Organization
Organization Name:MRI DIAGNOISTIC AND IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-420-0111
Mailing Address - Street 1:230 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9447
Mailing Address - Country:US
Mailing Address - Phone:570-424-6300
Mailing Address - Fax:570-420-0746
Practice Address - Street 1:230 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9447
Practice Address - Country:US
Practice Address - Phone:570-424-6300
Practice Address - Fax:570-420-0746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEASTERN REHABILIATION AND PAIN MANAGEMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty