Healthcare Provider Details

I. General information

NPI: 1154424026
Provider Name (Legal Business Name): EASTWICK RADIOLOGY ASSOCS.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SOUTH 54TH STREET MERCY FITZGERALD OUTPATIENT CENTER
DARBY PA
19023
US

IV. Provider business mailing address

501 SOUTH 54TH ST.
DARBY PA
19023-1330
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-2525
  • Fax:
Mailing address:
  • Phone: 610-237-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. JOSEPH H. BRADLEY
Title or Position: CFO
Credential:
Phone: 610-567-6771