Provider Demographics
NPI:1154424026
Name:EASTWICK RADIOLOGY ASSOCS.
Entity type:Organization
Organization Name:EASTWICK RADIOLOGY ASSOCS.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-567-6771
Mailing Address - Street 1:501 SOUTH 54TH ST.
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1330
Mailing Address - Country:US
Mailing Address - Phone:610-237-2525
Mailing Address - Fax:
Practice Address - Street 1:501 SOUTH 54TH STREET
Practice Address - Street 2:MERCY FITZGERALD OUTPATIENT CENTER
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023
Practice Address - Country:US
Practice Address - Phone:610-237-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39S156OtherMEDICARE ID TYPE UNSPECIFIED