Provider Demographics
NPI:1649232455
Name:NYDIC OPEN MRI OF AMERICA-MAHWAH VALLEY, LLC
Entity Type:Organization
Organization Name:NYDIC OPEN MRI OF AMERICA-MAHWAH VALLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUCHWALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-573-8080
Mailing Address - Street 1:100 PARAGON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1718
Mailing Address - Country:US
Mailing Address - Phone:201-573-8080
Mailing Address - Fax:201-775-4306
Practice Address - Street 1:400 FRANKLIN TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3516
Practice Address - Country:US
Practice Address - Phone:201-760-9500
Practice Address - Fax:201-760-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22517261QM1200X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4196850OtherGHI
NJ1440067OtherUNITED HEALTHCARE OF NJ
NJWS5721OtherWELLCHOICE
NJ22160OtherMEDFOCUS
NJ3082416OtherCIGNA PPO
NJ22911OtherUNIVERSITY HEALTH PLAN
NJ7419309Medicaid
NJ2K1317OtherHEALTHNET
NJ5922493OtherAETNA NON-HMO
NJA463305OtherOXFORD
NJ1078395OtherFIRST HEALTH NETWORK
NJ2819104OtherAETNA HMO
NJ37574OtherAMERICAID AMERIGROUP
NJ1440067OtherUNITED HEALTHCARE OF NJ