Provider Demographics
NPI:1295805547
Name:EASTERN PENNSYLVANIA IMAGING CONSULTANTS, PC
Entity type:Organization
Organization Name:EASTERN PENNSYLVANIA IMAGING CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, RADIOLOGY DEPARTMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-250-4000
Mailing Address - Street 1:2430 BUTLER STREET
Mailing Address - Street 2:SUITE 114
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-5303
Mailing Address - Country:US
Mailing Address - Phone:610-250-4000
Mailing Address - Fax:610-923-8160
Practice Address - Street 1:250 S 21ST ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3851
Practice Address - Country:US
Practice Address - Phone:610-250-4592
Practice Address - Fax:610-923-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018285300001OtherMEDICAID
PA109047Medicare ID - Type Unspecified