Provider Demographics
NPI:1952330599
Name:LOURDES IMAGING ASSOCIATES PA
Entity Type:Organization
Organization Name:LOURDES IMAGING ASSOCIATES PA
Other - Org Name:PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:BROUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-420-2770
Mailing Address - Street 1:PO BOX 31037
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101
Mailing Address - Country:US
Mailing Address - Phone:856-616-8100
Mailing Address - Fax:856-616-1919
Practice Address - Street 1:1600 HADDON AVENUE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3117
Practice Address - Country:US
Practice Address - Phone:856-616-8100
Practice Address - Fax:856-616-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7224702Medicaid
NJ707067Medicare ID - Type Unspecified