Provider Demographics
NPI:1124796420
Name:ADVANCED MEDICAL IMAGING PROFESSIONALS LLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL IMAGING PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKABERIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-227-1200
Mailing Address - Street 1:510 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3057
Mailing Address - Country:US
Mailing Address - Phone:917-379-7141
Mailing Address - Fax:732-837-4514
Practice Address - Street 1:510 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3057
Practice Address - Country:US
Practice Address - Phone:917-379-7141
Practice Address - Fax:732-837-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology