NPIMap

Organization Active NPI

East Brunswick Imaging Center LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • East Brunswick, NJ
National Provider Identifier
1124568910
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X
License
24450 Issued in NJ
Legal business name
EAST BRUNSWICK IMAGING CENTER LLC
Practice address
647 Route 18
Suite W
East Brunswick, NJ 08816-3747
Phone
(732) 613-6300
Fax
(732) 613-6318
NPI assigned
Feb 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Authorized official

Name
Mr. Roman Shaposhnikov
Title
Administrator
Phone
(732) 513-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X 24450 NJ Primary

Addresses

Primary practice location

647 Route 18
Suite W
East Brunswick, NJ 08816-3747

Mailing address

647 Route 18
Suite W
East Brunswick, NJ 08816-3747
Phone (732) 613-6300

Other identifiers 1

IdentifierTypeStateIssuer
24450OtherNJSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170802002132 NJ Part B Supplier - Clinic/Group Practice 9133490683 Receives reassigned benefits from 6 practitioners
Practice locations: Lakewood, NJ; East Brunswick, NJ

National Provider Directory

National Provider Directory

Locations

647 Route 18
Ste W
East Brunswick, NJ 08816
Phone (732) 613-6300

Practitioners & affiliated clinicians

Practitioners 6

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": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1124568910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 ROUTE 18",
            "address_2": "SUITE W",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163747",
            "telephone_number": "732-613-6300",
            "fax_number": "732-613-6318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 ROUTE 18",
            "address_2": "SUITE W",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088163747",
            "telephone_number": "732-613-6300",
            "fax_number": "732-613-6318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BRUNSWICK IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2017-02-28",
        "status": "A",
        "authorized_official_last_name": "SHAPOSHNIKOV",
        "authorized_official_first_name": "ROMAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "732-513-6300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "NJ",
            "license": "24450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "24450",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Brunswick, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.