Provider Demographics
NPI:1912238874
Name:MYRON MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:MYRON MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUABENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-207-1828
Mailing Address - Street 1:218 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1152
Mailing Address - Country:US
Mailing Address - Phone:973-207-1828
Mailing Address - Fax:
Practice Address - Street 1:218 N 10TH ST
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1152
Practice Address - Country:US
Practice Address - Phone:973-207-1828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04036000261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile