1174983498 NPI number — CHILDRENS RADIOLOGY ASSOCIATES OF NEW JERSEY PC

Table of content: (NPI 1174983498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174983498 NPI number — CHILDRENS RADIOLOGY ASSOCIATES OF NEW JERSEY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS RADIOLOGY ASSOCIATES OF NEW JERSEY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1174983498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E PENN SQ FL 9
Provider Second Line Business Mailing Address:
RACH NJ
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-3377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-425-9408
Provider Business Mailing Address Fax Number:
267-425-9299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1012 LAUREL OAK RD
Provider Second Line Business Practice Location Address:
RACH NJ @VOORHEES SCC
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-425-9233
Provider Business Practice Location Address Fax Number:
267-425-9625
Provider Enumeration Date:
02/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FLOWERS
Authorized Official First Name:
CHERISH
Authorized Official Middle Name:
Authorized Official Title or Position:
ENROLLMENT MANAGER
Authorized Official Telephone Number:
267-425-9408

Provider Taxonomy Codes

  • Taxonomy code: 2085P0229X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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