Provider Demographics
NPI:1225146020
Name:SOUTH MOUNTAIN IMAGING
Entity Type:Organization
Organization Name:SOUTH MOUNTAIN IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NORKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-376-0900
Mailing Address - Street 1:120 MILLBURN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:973-376-0900
Mailing Address - Fax:973-376-0010
Practice Address - Street 1:120 MILLBURNAVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-376-0900
Practice Address - Fax:973-376-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2996308Medicaid
527799Medicare ID - Type Unspecified