Provider Demographics
NPI:1396719993
Name:IMAGING CENTER OF MONTVILLE LLC
Entity type:Organization
Organization Name:IMAGING CENTER OF MONTVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-401-6823
Mailing Address - Street 1:200 AMERICAN RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2449
Mailing Address - Country:US
Mailing Address - Phone:973-538-9218
Mailing Address - Fax:973-540-8816
Practice Address - Street 1:350 MAIN RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9222
Practice Address - Country:US
Practice Address - Phone:973-401-6800
Practice Address - Fax:973-316-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ234492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0088773Medicaid
NJ089833Medicare ID - Type Unspecified