Provider Demographics
NPI:1467407288
Name:XRA, P.A.
Entity Type:Organization
Organization Name:XRA, P.A.
Other - Org Name:XRAY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEZZACAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-240-1400
Mailing Address - Street 1:19 MULE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5029
Mailing Address - Country:US
Mailing Address - Phone:732-240-1400
Mailing Address - Fax:732-341-3588
Practice Address - Street 1:19 MULE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5029
Practice Address - Country:US
Practice Address - Phone:732-240-1400
Practice Address - Fax:732-341-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2778700Medicaid
NJ=========OtherBCBS