Provider Demographics
NPI:1891099362
Name:COLUMBUS IMAGING CENTER LLC
Entity Type:Organization
Organization Name:COLUMBUS IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REUVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-481-7770
Mailing Address - Street 1:481-495 NORTH 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1317
Mailing Address - Country:US
Mailing Address - Phone:201-481-7770
Mailing Address - Fax:201-481-7755
Practice Address - Street 1:481-495 NORTH 13TH STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1317
Practice Address - Country:US
Practice Address - Phone:201-481-7770
Practice Address - Fax:201-481-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24404261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)