Provider Demographics
NPI:1184722456
Name:AMERICAN IMAGING OF BLOOMFIELD LLC
Entity type:Organization
Organization Name:AMERICAN IMAGING OF BLOOMFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TESTARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-669-1989
Mailing Address - Street 1:350 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4897
Mailing Address - Country:US
Mailing Address - Phone:973-743-6611
Mailing Address - Fax:
Practice Address - Street 1:350 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4897
Practice Address - Country:US
Practice Address - Phone:973-743-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ82455261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0108961Medicaid
NJUNITE HEALTH CAREOther41247001
NJMERCYOther60016050
NJTAX IDOther0108961
NJOXFORDOtherA3409221
NJAETNAOther3687113
NJOXFORDOtherA3409221
NJUNITE HEALTH CAREOther41247001
NJ093513Medicare ID - Type Unspecified