Provider Demographics
NPI:1629096219
Name:MEMORIAL RADIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MEMORIAL RADIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SWAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-267-1274
Mailing Address - Street 1:10 LANIDEX PLZ W
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2715
Mailing Address - Country:US
Mailing Address - Phone:973-267-1274
Mailing Address - Fax:973-267-2912
Practice Address - Street 1:10 LANIDEX PLZ W
Practice Address - Street 2:SUITE 125
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2715
Practice Address - Country:US
Practice Address - Phone:973-503-5700
Practice Address - Fax:973-386-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA042599002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093795Medicare ID - Type Unspecified