Basic Information
| Provider Information | |||||||||
| NPI: | 1043255284 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYDIC OPEN MRI OF AMERICA-WESTCHESTER, L.L.C. | ||||||||
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| OtherOrganizationName: | NYDIC-WESTCHESTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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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: | 4 WESTBROOK CORPORATE CTR | ||||||||
| Address2: | TOWER 4, SUITE 40 | ||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088361050 | ||||||||
| FaxNumber: | 7088361060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHWALTER | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2015738080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 5251666 | 01 | IL | AETNA US HEALTHCARE | OTHER | 2204858 | 01 | IL | AETNA US HEALTHCARE | OTHER | 01621906 | 01 | IL | BCBS OF ILLINOIS | OTHER | 5626535002 | 01 | IL | CIGNA HEALTHCARE | OTHER |