Provider Demographics
NPI:1154749455
Name:FRANKLIN LAKES MEDICAL IMAGING, LLC
Entity type:Organization
Organization Name:FRANKLIN LAKES MEDICAL IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONTEMPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-483-6955
Mailing Address - Street 1:30 W CENTURY RD
Mailing Address - Street 2:PARAMUS MEDICAL IMAGING SUITE 100
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1433
Mailing Address - Country:US
Mailing Address - Phone:201-483-6955
Mailing Address - Fax:
Practice Address - Street 1:784 FRANKLIN AVE
Practice Address - Street 2:FRANKLIN LAKES MEDICAL IMAGING SUITE 120
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1306
Practice Address - Country:US
Practice Address - Phone:201-891-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24825261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)