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General NPI Number Information
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NPI Number | 1447205968
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Entity Type | Organization
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Legal Business Name | PENNSAUKEN IMAGING, LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 6027 ROUTE 130 SOUTH
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City | PENNSAUKEN
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State | NJ
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Zip | 08110
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Country | US
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Telephone | 856-662-6161
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Fax | 856-662-4311
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Provider Business Mailing Address
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Address Line | 6027 ROUTE 130 SOUTH
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City | PENNSAUKEN
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State | NJ
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Zip | 08110
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Country | US
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Telephone | 856-662-6161
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Fax | 856-662-4311
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JEFF TUREK
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Credential |
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Telephone | 856-662-6161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 23329
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License Number State | NJ
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