Organization Active NPI

Ironbound MRI, LLC

  • Body Imaging Physician
  • Newark, NJ
National Provider Identifier
1104952290
Registry record updated Sep 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
IRONBOUND MRI, LLC
Practice address
119 Clifford Street
Newark, NJ 07105
Phone
(973) 508-1400
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2007

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

Authorized official

Name
Michael Davit
Title
Director
Phone
(973) 508-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085B0100X Primary

Addresses

Primary practice location

119 Clifford Street
Newark, NJ 07105

Mailing address

119 Clifford Street
Newark, NJ 07105
Phone (973) 508-1400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070411000192 NJ Part B Supplier - Clinic/Group Practice 6204931785 Receives reassigned benefits from 3 practitioners
Practice locations: Newark, NJ

National Provider Directory

National Provider Directory

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": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1104952290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 CLIFFORD STREET",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "07105",
            "telephone_number": "973-508-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 CLIFFORD STREET",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "07105",
            "telephone_number": "973-508-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRONBOUND MRI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2007-09-19",
        "status": "A",
        "authorized_official_last_name": "DAVIT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "973-508-1400"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; 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.