McBride Imaging Center LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

MCBRIDE IMAGING CENTER LLC

Practice address

1167 McBride Ave
Woodland Park, NJ 07424-2556

Phone

(201) 348-9225

NPI assigned

Feb 28, 2013

Last updated

May 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lawrence Gugliotta

Title

Managing Member

Phone

(973) 837-8100

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684368000000",
    "number": "1972843852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1167 MCBRIDE AVE STE 3",
            "city": "WOODLAND PARK",
            "state": "NJ",
            "postal_code": "074242543",
            "telephone_number": "973-837-8100",
            "fax_number": "973-837-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1167 MCBRIDE AVE",
            "city": "WOODLAND PARK",
            "state": "NJ",
            "postal_code": "074242556",
            "telephone_number": "201-348-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCBRIDE IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-28",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A",
        "authorized_official_last_name": "GUGLIOTTA",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "973-837-8100"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0418781",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel Issam Mallouhi, MD
• Anel Iveth Marquez, AGPCNP-BC
• Shannon Marren, PA-C
• Michael Joseph Martino, MD
• McBride Anesthesia LLC
• McBride Surgical Center, LLC
• Medpro Solutions
• Donna Mosslehi, LPC
• Sarah M Mourad, DMD
• New Jersey Advanced Gastroenterology, LLC

• Diagnostic Radiology Physician in Woodland Park, NJ
• Providers in Woodland Park, NJ by specialty
• Diagnostic Radiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; 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.