Provider Demographics
NPI:1578569679
Name:TRISTATE IMAGING CONSULTANTS, LLC
Entity Type:Organization
Organization Name:TRISTATE IMAGING CONSULTANTS, LLC
Other - Org Name:MANAHAWKIN OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-663-5910
Mailing Address - Street 1:PO BOX 827275
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7275
Mailing Address - Country:US
Mailing Address - Phone:215-663-5910
Mailing Address - Fax:215-663-2451
Practice Address - Street 1:1322 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2489
Practice Address - Country:US
Practice Address - Phone:609-978-7900
Practice Address - Fax:609-978-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8488207Medicaid
NJ8488207Medicaid