Provider Demographics
NPI:1225033541
Name:ADLER INSTITUTE FOR ADVANCED IMAGING, LLC.
Entity Type:Organization
Organization Name:ADLER INSTITUTE FOR ADVANCED IMAGING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/ACTIVE, ATTENDING
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-887-2102
Mailing Address - Street 1:261 OLD YORK RD
Mailing Address - Street 2:STE 106
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3706
Mailing Address - Country:US
Mailing Address - Phone:215-887-2102
Mailing Address - Fax:215-887-0525
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:STE 106
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-887-2102
Practice Address - Fax:215-887-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029568E207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10109346460001Medicaid
PA10109346460001Medicaid