Provider Demographics
NPI:1730862483
Name:IMAGING CENTER OF ENGLEWOOD. LLC
Entity type:Organization
Organization Name:IMAGING CENTER OF ENGLEWOOD. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIORA
Authorized Official - Middle Name:
Authorized Official - Last Name:NABIEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-731-3507
Mailing Address - Street 1:177 N DEAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 N DEAN ST STE 202
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2522
Practice Address - Country:US
Practice Address - Phone:201-731-3507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)