Provider Demographics
NPI:1316092364
Name:JAH RADIOLOGY PA
Entity type:Organization
Organization Name:JAH RADIOLOGY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEIMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-751-2011
Mailing Address - Street 1:36 NEWARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4119
Mailing Address - Country:US
Mailing Address - Phone:973-844-4170
Mailing Address - Fax:973-844-4192
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4119
Practice Address - Country:US
Practice Address - Phone:973-844-4170
Practice Address - Fax:973-844-4192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3429806Medicaid
NJ3429806Medicaid