Organization Active NPI

Cliffside Park Imaging and Diagnostic Center, LLC

  • Diagnostic Radiology Physician
  • Cliffside Park, NJ
National Provider Identifier
1104843689
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CLIFFSIDE PARK IMAGING AND DIAGNOSTIC CENTER, LLC
Practice address
596 Anderson Avenue
Suite 120
Cliffside Park, NJ 07010
Phone
(201) 945-6747
NPI assigned
Jul 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael Davit
Title
Manager
Phone
(201) 724-8124

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

596 Anderson Avenue
Suite 120
Cliffside Park, NJ 07010

Mailing address

596 Anderson Avenue
Suite 120
Cliffside Park, NJ 07010
Phone (201) 945-6747

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061103000425 NJ Part B Supplier - Clinic/Group Practice 0547267593 Receives reassigned benefits from 3 practitioners
Practice locations: Cliffside Park, NJ

National Provider Directory

National Provider Directory

Locations

596 Anderson Ave
Ste 120
Cliffside Pk, NJ 07010
Phone (201) 945-5747

Practitioners & affiliated clinicians

Practitioners 4

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": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104843689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 ANDERSON AVENUE",
            "address_2": "SUITE 120",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "07010",
            "telephone_number": "201-945-6747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 ANDERSON AVENUE",
            "address_2": "SUITE 120",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "07010",
            "telephone_number": "201-945-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLIFFSIDE PARK IMAGING AND DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "201-724-8124",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cliffside Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.