Provider Demographics
NPI:1336190784
Name:RADIOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-574-0742
Mailing Address - Street 1:PO BOX 828050
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8050
Mailing Address - Country:US
Mailing Address - Phone:866-553-9994
Mailing Address - Fax:207-347-7401
Practice Address - Street 1:727 NORTH BEERS STREET
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-381-8686
Practice Address - Fax:732-499-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA059390002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2613409Medicaid
NJ2613409Medicaid