Provider Demographics
NPI:1750332755
Name:SUFFERN RADIOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SUFFERN RADIOLOGY ASSOCIATES, P.C.
Other - Org Name:PET/CT IMAGING OF RAMAPO RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOBROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-368-5000
Mailing Address - Street 1:972 ROUTE 45
Mailing Address - Street 2:POMONA PROFESSIONAL PLAZA
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3519
Mailing Address - Country:US
Mailing Address - Phone:845-354-8909
Mailing Address - Fax:845-354-8910
Practice Address - Street 1:972 ROUTE 45
Practice Address - Street 2:POMONA PROFESSIONAL PLAZA
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3519
Practice Address - Country:US
Practice Address - Phone:845-354-8909
Practice Address - Fax:845-354-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-14
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
W21711Medicare ID - Type Unspecified