Provider Demographics
NPI:1184861817
Name:AMERICAN OPEN MRI, PC
Entity type:Organization
Organization Name:AMERICAN OPEN MRI, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMAROO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-263-2208
Mailing Address - Street 1:11120 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6341
Mailing Address - Country:US
Mailing Address - Phone:718-263-2208
Mailing Address - Fax:718-263-3442
Practice Address - Street 1:11120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6341
Practice Address - Country:US
Practice Address - Phone:718-263-2208
Practice Address - Fax:718-263-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1253162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00562809Medicaid
NYB14878Medicare UPIN
NY01957Medicare PIN