1538394168 NPI number — RAMAPO/PRS RADIOLOGY, P.C.

Table of content: LARI MICHELLE JENNINGS M.D. (NPI 1285623090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538394168 NPI number — RAMAPO/PRS RADIOLOGY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMAPO/PRS RADIOLOGY, 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:
1538394168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 ROBINSON AVENUE
Provider Second Line Business Mailing Address:
C/O ORANGE RADIOLOGY ASSOCIATES, P.C.
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-3353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-565-1989
Provider Business Mailing Address Fax Number:
845-863-0072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-6720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-802-0400
Provider Business Practice Location Address Fax Number:
845-802-0409
Provider Enumeration Date:
05/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BOBROFF
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-368-5000

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)





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