Healthcare Provider Details

I. General information

NPI: 1477551653
Provider Name (Legal Business Name): SOUTH JERSEY RADIOLOGY ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARNIE BLVD SUITE B-5
VOORHEES NJ
08043-4512
US

IV. Provider business mailing address

400 FELLOWSHIP RD STE 200
MOUNT LAUREL NJ
08054-3437
US

V. Phone/Fax

Practice location:
  • Phone: 856-751-0123
  • Fax: 856-751-0535
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number429966
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATE ROELLE
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 614-689-1691