Provider Demographics
NPI:1447205968
Name:PENNSAUKEN IMAGING, LLC
Entity Type:Organization
Organization Name:PENNSAUKEN IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:TUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-662-6161
Mailing Address - Street 1:6027 ROUTE 130 SOUTH
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110
Mailing Address - Country:US
Mailing Address - Phone:856-662-6161
Mailing Address - Fax:856-662-4311
Practice Address - Street 1:6027 ROUTE 130 SOUTH
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110
Practice Address - Country:US
Practice Address - Phone:856-662-6161
Practice Address - Fax:856-662-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ233292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0081264Medicaid
NJ095094Medicare PIN
NJDE0315Medicare PIN