Provider Demographics
NPI:1841381407
Name:DIAGNOSTIC IMAGING ASSOCIATES OF NORTH JERSEY PA
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING ASSOCIATES OF NORTH JERSEY PA
Other - Org Name:FAIR LAWN DIAGNOSTIC IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-418-6214
Mailing Address - Street 1:700 W VIRGINIA ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1549
Mailing Address - Country:US
Mailing Address - Phone:877-816-1467
Mailing Address - Fax:309-689-8902
Practice Address - Street 1:19-04 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2341
Practice Address - Country:US
Practice Address - Phone:201-794-3132
Practice Address - Fax:201-794-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2021-10-20
Deactivation Date:2021-08-26
Deactivation Code:
Reactivation Date:2021-10-20
Provider Licenses
StateLicense IDTaxonomies
NJ22535261QR0200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2893100Medicaid
527315Medicare PIN