Basic Information
| Provider Information | |||||||||
| NPI: | 1659374684 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYDIC OPEN MRI OF AMERICA-BOARDMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARAGON DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015738080 | ||||||||
| FaxNumber: | 2015058905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1449 BOARDMAN CANFIELD RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445128070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309657370 | ||||||||
| FaxNumber: | 3309657377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHWALTER | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2015738080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | X | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QM1200X | 0838-IC | OH | X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 175279 | 01 | OH | UNISON | OTHER | 37524 | 01 | OH | NATIONWIDE HEALTH PLANS | OTHER | 2433601 | 05 | OH | MEDICAID | 5739664 | 01 | OH | AETNA USHC ALL PLANS | OTHER | 1206654 | 01 | OH | FIRST HEALTH NETWORK | OTHER | 21503 | 01 | OH | MEDFOCUS | OTHER | 16-01304 | 01 | OH | UNITED HC OF OHIO | OTHER | 34187720100 | 01 | OH | BWC | OTHER |