Provider Demographics
NPI:1124027909
Name:QUAKERBRIDGE RADIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:QUAKERBRIDGE RADIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-890-0033
Mailing Address - Street 1:3535 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1200
Mailing Address - Country:US
Mailing Address - Phone:609-890-0033
Mailing Address - Fax:609-689-6067
Practice Address - Street 1:8 QUAKERBRIDGE PLZ
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1255
Practice Address - Country:US
Practice Address - Phone:609-890-0033
Practice Address - Fax:609-890-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ227692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2727102Medicaid
NJ440004Medicare ID - Type Unspecified