Provider Demographics
NPI:1245539386
Name:PRIME RADIOLOGY LLC
Entity type:Organization
Organization Name:PRIME RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-212-0051
Mailing Address - Street 1:66 WEST GILBERT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:1036 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2870
Practice Address - Country:US
Practice Address - Phone:732-225-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology