1003830571 NPI number — SOUTH JERSEY IMAGING ASSOCIATES PA

Table of content: (NPI 1003830571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003830571 NPI number — SOUTH JERSEY IMAGING ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH JERSEY IMAGING ASSOCIATES PA
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:
UPRIGHT IMAGING OF CHERRY HILL
Provider Other Organization Name Type Code:
3
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:
1003830571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 BRIGGS RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-231-4774
Provider Business Mailing Address Fax Number:
856-231-9699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 ROUTE 38
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08002-2955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-486-9000
Provider Business Practice Location Address Fax Number:
856-486-9149
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOREA
Authorized Official First Name:
GAETANO
Authorized Official Middle Name:
TOM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
856-486-9000

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3203406 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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