Provider Demographics
NPI:1740700749
Name:SJM RADIOLOGY, P.C.
Entity type:Organization
Organization Name:SJM RADIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-760-9500
Mailing Address - Street 1:14 CROSSROADS CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5064
Mailing Address - Country:US
Mailing Address - Phone:914-220-8300
Mailing Address - Fax:
Practice Address - Street 1:2 OVERHILL ROAD
Practice Address - Street 2:#400
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-220-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherGENERAL
=========OtherGENERAL PRACTICE