Provider Demographics
NPI:1205900404
Name:THIRD AVENUE OPEN MRI, INC
Entity type:Organization
Organization Name:THIRD AVENUE OPEN MRI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-402-0300
Mailing Address - Street 1:2781 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4002
Mailing Address - Country:US
Mailing Address - Phone:718-402-0300
Mailing Address - Fax:
Practice Address - Street 1:2781 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4002
Practice Address - Country:US
Practice Address - Phone:718-402-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000258R261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)