Provider Demographics
NPI:1619393402
Name:PRINCETON RADIOLOGY AT QUAKERBRIDGE LLC
Entity Type:Organization
Organization Name:PRINCETON RADIOLOGY AT QUAKERBRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-821-5563
Mailing Address - Street 1:3674 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:731-821-5563
Mailing Address - Fax:732-821-3250
Practice Address - Street 1:8 QUAKERBRIDGE PLACE DRIVE
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:732-821-5563
Practice Address - Fax:732-821-3250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCETON RADIOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ233312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty