Basic Information
| Provider Information | |||||||||
| NPI: | 1922040377 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAMMONTON IMAGING ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 BRIGGS RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080544100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562314774 | ||||||||
| FaxNumber: | 8562319699 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 S WHITE HORSE PIKE | ||||||||
| Address2: | IMAGING CENTER | ||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080372014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095616700 | ||||||||
| FaxNumber: | 6095618370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GONNELLA | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6095616700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085U0001X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
No ID Information.