Provider Demographics
NPI:1952467284
Name:EDISON IMAGING ASSOCIATES PA
Entity Type:Organization
Organization Name:EDISON IMAGING ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-668-0304
Mailing Address - Street 1:PO BOX 2178
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08818-2178
Mailing Address - Country:US
Mailing Address - Phone:908-668-0304
Mailing Address - Fax:908-668-0503
Practice Address - Street 1:60 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3938
Practice Address - Country:US
Practice Address - Phone:908-668-0304
Practice Address - Fax:908-668-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3402606Medicaid
NJ3402606Medicaid