Provider Demographics
NPI:1659374684
Name:NYDIC OPEN MRI OF AMERICA-BOARDMAN
Entity Type:Organization
Organization Name:NYDIC OPEN MRI OF AMERICA-BOARDMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:STE 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:201-505-8905
Practice Address - Street 1:1449 BOARDMAN CANFIELD RD
Practice Address - Street 2:STE 140
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-8070
Practice Address - Country:US
Practice Address - Phone:330-965-7370
Practice Address - Fax:330-965-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0838-IC261QM1200X
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
OH175279OtherUNISON
OH37524OtherNATIONWIDE HEALTH PLANS
OH2433601Medicaid
OH5739664OtherAETNA USHC ALL PLANS
OH1206654OtherFIRST HEALTH NETWORK
OH21503OtherMEDFOCUS
OH16-01304OtherUNITED HC OF OHIO
OH34187720100OtherBWC
OH37524OtherNATIONWIDE HEALTH PLANS
OH34187720100OtherBWC
OH2433601Medicaid