Provider Demographics
NPI:1376649798
Name:MIDWAY RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MIDWAY RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-561-3095
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-0750
Mailing Address - Country:US
Mailing Address - Phone:609-561-9729
Mailing Address - Fax:609-567-8178
Practice Address - Street 1:856 S WHITE HORSE PIKE STE C-6
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2032
Practice Address - Country:US
Practice Address - Phone:609-561-9729
Practice Address - Fax:609-567-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5109205Medicaid
NJ668355Medicare ID - Type Unspecified