NPIMap

Organization Active NPI

Advanced Diagnostic Imaging of New Jersey Inc

  • Radiology Clinic/Center
  • Paramus, NJ
National Provider Identifier
1114044708
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
22548 Issued in NJ
Legal business name
ADVANCED DIAGNOSTIC IMAGING OF NEW JERSEY INC
Practice address
34 State Highway Route 17 North
Paramus, NJ 07652
Phone
(201) 368-2005
Fax
(201) 368-1431
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Authorized official

Name
Mr. Victor M Mora
Title
Administrator,
Phone
(201) 368-2005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 22548 NJ Primary

Addresses

Primary practice location

34 State Highway Route 17 North
Paramus, NJ 07652

Mailing address

34 Route 17 North
Paramus, NJ 07652
Phone (201) 368-2005

Other identifiers 2

IdentifierTypeStateIssuer
374421OtherNJPTAN
8149909MedicaidNJ

National Provider Directory

National Provider Directory

Locations

34 State Route 17
Paramus, NJ 07652
Phone (201) 368-2005

34 N Route 17
Paramus, NJ 07652
Phone (201) 368-2005

Practitioners & affiliated clinicians

Practitioners 5

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": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1114044708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 ROUTE 17 NORTH",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "07652",
            "telephone_number": "201-368-2005",
            "fax_number": "201-368-1431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 STATE HIGHWAY ROUTE 17 NORTH",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "07652",
            "telephone_number": "201-368-2005",
            "fax_number": "201-368-1431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIAGNOSTIC IMAGING OF NEW JERSEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "MORA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR,",
        "authorized_official_telephone_number": "201-368-2005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NJ",
            "license": "22548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "374421",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8149909",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paramus, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.