Provider Demographics
NPI:1497748990
Name:IMAGING ASSOCIATES PA
Entity Type:Organization
Organization Name:IMAGING ASSOCIATES PA
Other - Org Name:HACKENSACK DIAGNOSTIC IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-236-0220
Mailing Address - Street 1:1455 BROAD ST
Mailing Address - Street 2:4TH FLOOR IMAGING ASSOCIATES PA
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3003
Mailing Address - Country:US
Mailing Address - Phone:973-873-9889
Mailing Address - Fax:973-707-1127
Practice Address - Street 1:433 HACKENSACK AVE
Practice Address - Street 2:LOWER LEVEL HACKENSACK DIAGNOSTIC IMAGING CENTER
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6319
Practice Address - Country:US
Practice Address - Phone:201-488-1144
Practice Address - Fax:201-488-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8021902Medicaid
NJ8021902Medicaid