Provider Demographics
NPI:1972843852
Name:MCBRIDE IMAGING CENTER LLC
Entity Type:Organization
Organization Name:MCBRIDE IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGLIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-837-8100
Mailing Address - Street 1:1167 MCBRIDE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2543
Mailing Address - Country:US
Mailing Address - Phone:973-837-8100
Mailing Address - Fax:973-837-8100
Practice Address - Street 1:1167 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2556
Practice Address - Country:US
Practice Address - Phone:201-348-9225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0418781Medicaid