| Organization Name: | NEW JERSEY MAXILLOFACIAL DIGITAL IMAGING CENTER |
| NPI Number: | 1326349465 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY E OLIVERIE (MEMBER) |
| Mailing Address: | 1516 Hwy 138 Wall |
| State: | NJ US |
| Postal Code: | 077193700 |
| Phone Number: | 7326815544 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2010 |
| NPI Last Update Date: | 11/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | DI20496 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |