Provider Demographics
NPI:1689619546
Name:EAST BRUNSWICK OPEN UPRIGHT MRI LLC
Entity Type:Organization
Organization Name:EAST BRUNSWICK OPEN UPRIGHT MRI LLC
Other - Org Name:IMAGECARE AT EAST BRUNSWICK OPEN UPRIGHT MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-361-7350
Mailing Address - Street 1:620 CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4000
Mailing Address - Country:US
Mailing Address - Phone:732-698-1717
Mailing Address - Fax:732-698-2727
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4000
Practice Address - Country:US
Practice Address - Phone:732-698-1717
Practice Address - Fax:732-698-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23103261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097791Medicare ID - Type Unspecified