Provider Demographics
NPI:1093893125
Name:MONROE RADIOLOGY IMAGING P C
Entity Type:Organization
Organization Name:MONROE RADIOLOGY IMAGING P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-421-8248
Mailing Address - Street 1:RR 2 BOX 2091C
Mailing Address - Street 2:
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9629
Mailing Address - Country:US
Mailing Address - Phone:570-421-8196
Mailing Address - Fax:570-476-6213
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-421-4000
Practice Address - Fax:570-476-6213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012536450003Medicaid
=========OtherFIN
PA0012536450003Medicaid