Provider Demographics
NPI:1952480659
Name:IRVINGTON MEDICAL IMAGING P.C.
Entity Type:Organization
Organization Name:IRVINGTON MEDICAL IMAGING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-351-1277
Mailing Address - Street 1:285 COIT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-4013
Mailing Address - Country:US
Mailing Address - Phone:973-351-1277
Mailing Address - Fax:973-351-1288
Practice Address - Street 1:285 COIT ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-4013
Practice Address - Country:US
Practice Address - Phone:973-351-1277
Practice Address - Fax:973-351-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23000261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)