Provider Demographics
NPI:1134176944
Name:BYBERRY MRI & DIAGNOSTIC ASSOCIATES
Entity type:Organization
Organization Name:BYBERRY MRI & DIAGNOSTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-947-7992
Mailing Address - Street 1:3501 MASONS MILL RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3517
Mailing Address - Country:US
Mailing Address - Phone:215-659-4755
Mailing Address - Fax:215-659-4764
Practice Address - Street 1:3501 MASONS MILL RD
Practice Address - Street 2:SUITE 502
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3517
Practice Address - Country:US
Practice Address - Phone:215-659-4755
Practice Address - Fax:215-659-4764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2221941000OtherIBC
PA076873Medicare PIN