Healthcare Provider Details

I. General information

NPI: 1205266392
Provider Name (Legal Business Name): STAND-UP MRI OF CHERRY HILL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROUTE 38
CHERRY HILL NJ
08002-2955
US

IV. Provider business mailing address

PO BOX 296
CEDAR BROOK NJ
08018-0296
US

V. Phone/Fax

Practice location:
  • Phone: 856-486-9000
  • Fax:
Mailing address:
  • Phone: 609-704-1857
  • Fax: 609-704-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number23487
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number23487
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number23487
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23487
License Number StateNJ

VIII. Authorized Official

Name: PAT MOREA
Title or Position: OWNER
Credential:
Phone: 973-335-5752