Basic Information
| Provider Information | |||||||||
| NPI: | 1053836635 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUANTUM MEDICAL RADIOLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 72444 | ||||||||
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| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441920002 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 PROVINCE LINE RD | ||||||||
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| City: | PRINCETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085407543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594554026 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2017 | ||||||||
| LastUpdateDate: | 08/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | FERRARO | ||||||||
| AuthorizedOfficialFirstName: | FRANCIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4048702802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.