Provider Demographics
NPI:1477710317
Name:PLAZA WEST DIAGNOSTIC & TREATMENT CENTER
Entity Type:Organization
Organization Name:PLAZA WEST DIAGNOSTIC & TREATMENT CENTER
Other - Org Name:DIAGNOSTIC & TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-585-8105
Mailing Address - Street 1:1475 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2176
Mailing Address - Country:US
Mailing Address - Phone:201-585-8105
Mailing Address - Fax:201-585-9862
Practice Address - Street 1:1475 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2176
Practice Address - Country:US
Practice Address - Phone:201-585-8105
Practice Address - Fax:201-585-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ32407261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care