Provider Demographics
NPI:1295086080
Name:POCONO MRI IMAGING AND DIAGNOSTIC CENTER,LLC
Entity type:Organization
Organization Name:POCONO MRI IMAGING AND DIAGNOSTIC CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BHAVNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-517-7393
Mailing Address - Street 1:3 PARKINSONS RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8087
Mailing Address - Country:US
Mailing Address - Phone:570-424-8000
Mailing Address - Fax:570-517-5100
Practice Address - Street 1:3 PARKINSONS RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8087
Practice Address - Country:US
Practice Address - Phone:570-424-8000
Practice Address - Fax:570-517-5100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POCONO MRI IMAGING AND DIAGNOSTIC CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107241Medicare PIN