Fairview Imaging Center Inc
Organization Active NPI Radiology Clinic/Center · Fairview, NJ
NPI 1053780916 · NPPES record last updated Sep 22, 2015
Key facts
- NPI
- 1053780916
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Radiology Clinic/Center 261QR0200X
- Legal business name
- FAIRVIEW IMAGING CENTER INC
- Practice address
- 178 Bergen Blvd
Fairview, NJ 07022-1620 - Phone
- (201) 313-3200
- Fax
- (201) 313-9700
- NPI assigned
- Sep 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Lama Saloukha
- Title
- Manager
- Phone
- (201) 313-3200
Practitioners 3
-
Feng Tao, MD
-
Ketang Modi, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171003006080 | NJ | Part B Supplier - Clinic/Group Practice | 6103191028 |
Receives reassigned benefits from 3 practitioners Practice locations: Fairview, NJ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiology Clinic/Center | 261QR0200X | Yes |
Addresses
Primary practice location
178 Bergen Blvd
Fairview, NJ 07022-1620
Mailing address
178 Bergen Blvd
Fairview, NJ 07022-1620
Phone (201) 313-3200
Other providers in Fairview, NJ
- Dr. Brian E. Kiczek
- Sarah Elhalawani
- Eyedeal Vision Center
- Fair Ridge Pharmacy Inc
- Fairview Board of Education
- Fairview Pharmacy LLC
- Ryan Thomas Finucane
- Fresenius Medical Care Fairview Dialysis, LLC
- Mina Garas
- Natalia Gomez
All providers in Fairview, NJ · Radiology Clinic/Center in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.