Provider Demographics
NPI:1578628772
Name:SHORE IMAGING ASSOCIATES MARLTON LLC
Entity Type:Organization
Organization Name:SHORE IMAGING ASSOCIATES MARLTON LLC
Other - Org Name:STAT IMAGING AT MARLTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:856-983-5599
Mailing Address - Street 1:324 44TH ST
Mailing Address - Street 2:
Mailing Address - City:SEA ISLE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08243-1846
Mailing Address - Country:US
Mailing Address - Phone:609-263-4566
Mailing Address - Fax:856-985-9061
Practice Address - Street 1:100 BRICK RD
Practice Address - Street 2:SUITE #101
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-983-5599
Practice Address - Fax:856-985-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22803261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)