Organization Active NPI

Clifton MRI LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Clifton, NJ
National Provider Identifier
1093222424
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
Legal business name
CLIFTON MRI LLC
Practice address
750 Clifton Ave
Clifton, NJ 07013
Phone
(973) 852-3690
Fax
(973) 852-3696
NPI assigned
Jan 8, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Oleksandr Washington
Title
Manager
Phone
(973) 852-3690

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X Primary
Radiology Clinic/Center 261QR0200X

Addresses

Primary practice location

750 Clifton Ave
Clifton, NJ 07013

Mailing address

750 Clifton Ave
Clifton, NJ 07013-1837
Phone (973) 852-3690

Other identifiers 2

IdentifierTypeStateIssuer
25091OtherNJNJ AMBULATORY CARE FACILITY LICENSE
0607410MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180214001357 NJ Part B Supplier - Clinic/Group Practice 3678833522 Receives reassigned benefits from 2 practitioners
Practice locations: Clifton, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1093222424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070131837",
            "telephone_number": "973-852-3690",
            "fax_number": "973-852-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 CLIFTON AVE",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "07013",
            "telephone_number": "973-852-3690",
            "fax_number": "973-852-3696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLIFTON MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-08",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "WASHINGTON",
        "authorized_official_first_name": "OLEKSANDR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "973-852-3690",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NJ AMBULATORY CARE FACILITY LICENSE",
            "identifier": "25091",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0607410",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.