Basic Information
| Provider Information | |||||||||
| NPI: | 1982650859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYDIC OPEN MRI OF AMERICA-PARAMUS, LLC | ||||||||
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| OtherOrganizationName: | NYDIC-PARAMUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 2 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076525246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013681888 | ||||||||
| FaxNumber: | 2013681442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| 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 | 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 | 1091689 | 01 | NJ | FIRST HEALTH NETWORK | OTHER | 2K1377 | 01 | NJ | HEALTHNET (PHS OF NJ) | OTHER | 36489 | 01 | NJ | AMERICAID/AMERIGROUP | OTHER | 492805 | 01 | NJ | ONE HEALTH PLAN OF NJ | OTHER | 594 | 01 | NJ | OXFORD-NYMI | OTHER | A745473 | 01 | NJ | OXFORD HEALTH PLANS | OTHER | WTB3011 | 01 | NJ | WELLCHOICE | OTHER | 1754053 | 01 | NJ | UNITED HEALTHCARE | OTHER | 2249654 | 01 | NJ | CIGNA PPO | OTHER | 5756601 | 01 | NJ | AETNA USHC NON-HMO | OTHER | 221661 | 01 | NJ | MEDFOCUS | OTHER | 7748205 | 05 | NJ | MEDICAID | 22912 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 4196898 | 01 | NJ | GHI | OTHER | A745473 | 01 | NJ | OXFORD | OTHER | 2819063 | 01 | NJ | AETNA US HEALTHCARE HMO | OTHER |