Provider Demographics
NPI:1952648073
Name:OPEN MRI AT WALL LABORATORIES LLC
Entity Type:Organization
Organization Name:OPEN MRI AT WALL LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPAOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-974-8060
Mailing Address - Street 1:1975 HIGHWAY 34 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-974-8060
Mailing Address - Fax:732-974-0001
Practice Address - Street 1:1975 HIGHWAY 34 SOUTH
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-974-8060
Practice Address - Fax:732-974-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D2043848291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory