Basic Information
| Provider Information | |||||||||
| NPI: | 1326191008 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRAIT PARTNOW MARGOLIN & SHARETTS MDS PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALSO MRI DIAGNOSTIC CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 VAN SCIVER PARKWAY | ||||||||
| Address2: | |||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080461132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098717500 | ||||||||
| FaxNumber: | 6098716026 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 VAN SCIVER PARKWAY | ||||||||
| Address2: | |||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080461132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098717500 | ||||||||
| FaxNumber: | 6098716026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | PARTNOW | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6098717500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 079851 | 01 | NJ | PA BLUE SHIELD | OTHER | 363582900 | 01 | US DEPT OF LABOR W | OTHER | CN1212 | 01 | RAILROAD MEDICARE | OTHER | 007712900 | 01 | AMERIHEALTH | OTHER | 007712900 | 01 | KEYSTONE HPE | OTHER | BU000005900 | 01 | NJ | AMERICHOICE | OTHER | 0002782 | 01 | AETNA | OTHER | 3099890 | 01 | GHI | OTHER | 113941900 | 01 | US DEPT OF LABOR M | OTHER | 0000F02083 | 01 | HEALTH NET | OTHER | 2811901 | 05 | NJ | MEDICAID | 1035083 | 01 | NJ | HORIZON NJ HEALTH | OTHER |