Provider Demographics
NPI:1770790115
Name:ROXBURY OPEN MRI AND SURGICAL CENTER LLC
Entity type:Organization
Organization Name:ROXBURY OPEN MRI AND SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SHANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-262-8274
Mailing Address - Street 1:66 SUNSET STRIP
Mailing Address - Street 2:101
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1345
Mailing Address - Country:US
Mailing Address - Phone:973-927-8100
Mailing Address - Fax:201-262-8718
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:101
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1345
Practice Address - Country:US
Practice Address - Phone:973-927-8100
Practice Address - Fax:201-262-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22512261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ015282Medicare PIN