Provider Demographics
NPI:1083710602
Name:SPRINGDALE RADIOLOGY, LLC
Entity Type:Organization
Organization Name:SPRINGDALE RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-424-2929
Mailing Address - Street 1:2051 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1603
Mailing Address - Country:US
Mailing Address - Phone:856-424-2929
Mailing Address - Fax:856-424-6111
Practice Address - Street 1:2051 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1603
Practice Address - Country:US
Practice Address - Phone:856-424-2929
Practice Address - Fax:856-424-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB363022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086627Medicare ID - Type Unspecified