Organization
EAST BRUNSWICK IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROMAN SHAPOSHNIKOV (ADMINISTRATOR)
(732) 513-6300
Entity
Organization
Contact information
Practice address
647 ROUTE 18, SUITE W, EAST BRUNSWICK, NJ 08816-3747
(732) 613-6300
(732) 613-6318
Mailing address
647 ROUTE 18, SUITE W, EAST BRUNSWICK, NJ 08816-3747
(732) 613-6300
(732) 613-6318
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
24450
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24450
STATE LICENSE
NJ
Enumeration date
02/28/2017
Last updated
02/28/2017
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