Provider Demographics
NPI:1447283916
Name:CEDAR CREST IMAGING
Entity type:Organization
Organization Name:CEDAR CREST IMAGING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SHINGLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-821-9105
Mailing Address - Street 1:1125 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7903
Mailing Address - Country:US
Mailing Address - Phone:610-821-9105
Mailing Address - Fax:
Practice Address - Street 1:1125 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7903
Practice Address - Country:US
Practice Address - Phone:610-821-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDAR CREST EMERGICENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2096289000OtherINDEPENDENCE BLUE CROSS
PA1408509OtherHIGHMARK BLUE SHIELD
PAA435968OtherOXFORD HEALTH PLAN
PACC8556OtherRAILROAD MEDICARE
PA027417700OtherCAPITAL BLUE CROSS
PA2096289000OtherAMERIHEALTH ADMINISTRATOR
PA462851Medicare ID - Type Unspecified
PA462851Medicare PIN