1093893125 NPI number — MONROE RADIOLOGY IMAGING P C

Table of content: (NPI 1093893125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093893125 NPI number — MONROE RADIOLOGY IMAGING P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE RADIOLOGY IMAGING P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093893125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR 2 BOX 2091C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
E STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18301-9629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-421-8196
Provider Business Mailing Address Fax Number:
570-476-6213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 E BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-4000
Provider Business Practice Location Address Fax Number:
570-476-6213
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAWK
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BUSINESS MGR
Authorized Official Telephone Number:
570-421-8248

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0012536450003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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