Advanced Maxillofacial Imaging Services

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

ADVANCED MAXILLOFACIAL IMAGING SERVICES

Practice address

21 N Gilbert St
Tinton Falls, NJ 07701-4950

Phone

(732) 747-0993

Fax

(732) 412-9317

NPI assigned

May 10, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Gary Brousell

Title

Owner

Phone

(732) 747-0993

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304985600000",
    "number": "1134411150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 N GILBERT ST",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014950",
            "telephone_number": "732-747-0993",
            "fax_number": "732-412-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 N GILBERT ST",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077014950",
            "telephone_number": "732-747-0993",
            "fax_number": "732-412-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MAXILLOFACIAL IMAGING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "last_updated": "2011-05-10",
        "status": "A",
        "authorized_official_last_name": "BROUSELL",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-747-0993",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.