Provider Demographics
NPI:1437125291
Name:ADVANCED OPEN MRI & DIAGNOSTIC IMAGING PA
Entity Type:Organization
Organization Name:ADVANCED OPEN MRI & DIAGNOSTIC IMAGING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-240-7757
Mailing Address - Street 1:751 RT 37 WEST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:732-240-7757
Mailing Address - Fax:732-240-7761
Practice Address - Street 1:751 RT 37 WEST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-240-7757
Practice Address - Fax:732-240-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22397261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7647603Medicaid
NJ012915Medicare ID - Type Unspecified