Provider Demographics
NPI:1669506176
Name:HACKETTSTOWN OPEN MRI
Entity Type:Organization
Organization Name:HACKETTSTOWN OPEN MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-652-1213
Mailing Address - Street 1:653 WILLOW GROVE ST
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1732
Mailing Address - Country:US
Mailing Address - Phone:908-850-3100
Mailing Address - Fax:908-850-5059
Practice Address - Street 1:653 WILLOW GROVE ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1732
Practice Address - Country:US
Practice Address - Phone:908-850-3100
Practice Address - Fax:908-850-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID