Provider Demographics
NPI:1437577368
Name:ODI DIAGNOSTIC IMAGING OF NEWARK LLC
Entity type:Organization
Organization Name:ODI DIAGNOSTIC IMAGING OF NEWARK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-521-5685
Mailing Address - Street 1:243 CHESTNUT ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-6501
Mailing Address - Country:US
Mailing Address - Phone:973-521-5685
Mailing Address - Fax:862-237-7629
Practice Address - Street 1:243 CHESTNUT ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-6501
Practice Address - Country:US
Practice Address - Phone:973-521-5685
Practice Address - Fax:862-237-7629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIC DIAGNOSTIC IMAGING CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-28
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23151261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)