Provider Demographics
NPI:1124130703
Name:PAVONIA DIAGNOSTIC IMAGING, PA
Entity type:Organization
Organization Name:PAVONIA DIAGNOSTIC IMAGING, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURIZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-222-3225
Mailing Address - Street 1:PO BOX 8328
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07308-8328
Mailing Address - Country:US
Mailing Address - Phone:201-222-3225
Mailing Address - Fax:201-499-0249
Practice Address - Street 1:600 PAVONIA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-222-3225
Practice Address - Fax:201-499-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty