Provider Demographics
NPI:1932337268
Name:NORTHERN TIER IMAGING CORP
Entity Type:Organization
Organization Name:NORTHERN TIER IMAGING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADEROWFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-281-1315
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0517
Mailing Address - Country:US
Mailing Address - Phone:570-281-1287
Mailing Address - Fax:570-281-1256
Practice Address - Street 1:638 FAIRVIEW ROAD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-8955
Practice Address - Country:US
Practice Address - Phone:570-281-1287
Practice Address - Fax:570-281-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070287L2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty