Provider Demographics
NPI:1437240843
Name:NORTH DOVER OPEN MRI LLC
Entity type:Organization
Organization Name:NORTH DOVER OPEN MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-370-9902
Mailing Address - Street 1:1215 HIGHWAY 70
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5947
Mailing Address - Country:US
Mailing Address - Phone:732-370-9902
Mailing Address - Fax:732-370-9908
Practice Address - Street 1:1215 HIGHWAY 70
Practice Address - Street 2:SUITE 1003
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5947
Practice Address - Country:US
Practice Address - Phone:732-370-9902
Practice Address - Fax:732-370-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24063261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ24063OtherSTATE LICENSE