Provider Demographics
NPI:1417013731
Name:EDISON RADIOLOGY GROUP PA JFK MEDICAL CENTER
Entity Type:Organization
Organization Name:EDISON RADIOLOGY GROUP PA JFK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESHKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-208-7069
Mailing Address - Street 1:PO BOX 3271
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3271
Mailing Address - Country:US
Mailing Address - Phone:800-208-7069
Mailing Address - Fax:
Practice Address - Street 1:65 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3947
Practice Address - Country:US
Practice Address - Phone:732-287-1702
Practice Address - Fax:732-287-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2610108Medicaid
NJ2610108Medicaid