Provider Demographics
NPI:1841422169
Name:MEDICAL & MOLECULAR IMAGING INC
Entity Type:Organization
Organization Name:MEDICAL & MOLECULAR IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARACHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-487-5300
Mailing Address - Street 1:155 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5419
Practice Address - Country:US
Practice Address - Phone:201-487-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ167885Medicare PIN