Basic Information
| Provider Information | |||||||||
| NPI: | 1013952225 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYDIC OPEN MRI OF AMERICA-PENSACOLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARAGON DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015738080 | ||||||||
| FaxNumber: | 2017754306 | ||||||||
| Practice Location | |||||||||
| Address1: | 5330 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504848666 | ||||||||
| FaxNumber: | 8504847663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHWALTER | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2015738080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261QR0200X | X | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1216008 | 01 | FL | FIRST HEALTH NETWORK | OTHER | 59026119 | 01 | FL | BCBS OF ALABAMA | OTHER | MR55114-61 | 01 | FL | SYNERGY INSURANCE SYSTEMS | OTHER | 20332 | 01 | FL | MEDFOCUS | OTHER | 34-00045 | 01 | FL | UNITED HEALTHCARE OF FL | OTHER | 7773831 | 01 | FL | CIGNA HEALTHCARE | OTHER | 7855117 | 01 | FL | AETNA US HEALTHCARE | OTHER | V2203 | 01 | FL | BCBS OF FLORIDA | OTHER |