Provider Demographics
NPI:1982798021
Name:OPEN MRI AT WALL, L.L.C.
Entity Type:Organization
Organization Name:OPEN MRI AT WALL, L.L.C.
Other - Org Name:OPEN MRI AND DIAGNOSTIC IMAGING OF WALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UNTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-974-8060
Mailing Address - Street 1:1975 STATE ROUTE 34
Mailing Address - Street 2:BLDG. D
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9750
Mailing Address - Country:US
Mailing Address - Phone:732-974-8060
Mailing Address - Fax:732-974-8820
Practice Address - Street 1:1975 STATE ROUTE 34
Practice Address - Street 2:BLDG. D
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-9750
Practice Address - Country:US
Practice Address - Phone:732-974-8060
Practice Address - Fax:732-974-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22832261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN
NJ044407Medicare ID - Type Unspecified