Organization
SOUTH JERSEY RADIOLOGY ASSOCIATES P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATE ROELLE (SR. DIRECTOR OF CREDENTIALING)
(614) 689-1691
Entity
Organization
Contact information
Practice address
100 CARNIE BLVD STE B5, VOORHEES, NJ 08043-4514
(888) 909-7572
Mailing address
400 FELLOWSHIP RD STE 200, MOUNT LAUREL, NJ 08054-3437
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
429966
NJ
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00099913000
AMERIHEALTH - HMO
—
01
—
0016366
AETNA
—
01
—
1100179
HORIZON NJ HEALTH
—
05
—
2612704
—
NJ
01
—
429966
PREMIER BLUE
—
01
—
46043
CAQH
—
01
—
CA3660
RAILROAD MEDICARE
—
Enumeration date
07/12/2005
Last updated
05/04/2026
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