Provider Demographics
NPI:1457516973
Name:JERSEY SHORE RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:JERSEY SHORE RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STRAWSER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-398-0100
Mailing Address - Street 1:415 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-4411
Mailing Address - Country:US
Mailing Address - Phone:570-208-5571
Mailing Address - Fax:570-208-5548
Practice Address - Street 1:1020 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1729
Practice Address - Country:US
Practice Address - Phone:570-398-0100
Practice Address - Fax:570-398-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty