Basic Information
| Provider Information | |||||||||
| NPI: | 1568598647 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRAIT, PARTNOW, MARGOLIN & SHARETTS, MD'S, PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MRI DIAGNOSTIC CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 231 VAN SCIVER PKWY | ||||||||
| Address2: | |||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080461132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098717777 | ||||||||
| FaxNumber: | 6098716026 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 VAN SCIVER PKWY | ||||||||
| Address2: | |||||||||
| City: | WILLINGBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080461132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098717777 | ||||||||
| FaxNumber: | 6098716026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PARTNOW | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | JEFFREY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6098717777 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BRAIT, PARTNOW, MARGOLIN & SHARETTS, MD'S, PA | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CN1212 | 01 | NJ | RAILROAD MEDICARE | OTHER | 1035083 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 2811901 | 05 | NJ | MEDICAID | 2K6219 | 01 | NJ | HEALTHNET | OTHER |