Provider Demographics
NPI:1164437547
Name:PRIME RADIOLOGY, LLC
Entity Type:Organization
Organization Name:PRIME RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-877-5287
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0052
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-877-5287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2085B0100X, 2085N0700X, 2085N0904X, 2085R0202X, 2085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological PhysicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8112304Medicaid
NJ1171435OtherHORIZON NJ HEALTH
NJ0095270001OtherAMERIHEALTH
NJ1943299OtherUNITED HEALTH CARE
NJJ11285OtherHEALTH NET
NJCG5834OtherRAILROAD MEDICARE
NJA2021347OtherOXFORD
NJWT154OtherWELLCHOICE
NJ1171435OtherHORIZON NJ HEALTH
NJA2021347OtherOXFORD