Provider Demographics
NPI:1720164734
Name:PROGRESSIVE MEDICAL IMAGING OF HACKENSACK, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL IMAGING OF HACKENSACK, LLC
Other - Org Name:PROGRESSIVE OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-5945
Mailing Address - Street 1:PO BOX 785961
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:201-541-5401
Mailing Address - Fax:201-541-5400
Practice Address - Street 1:385 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-488-4808
Practice Address - Fax:201-488-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23025261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055093Medicare ID - Type Unspecified