Alfio K Pennisi, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

25MA04964700 Issued in NJ

Practice address

100 Carnie Blvd
Suite B-5
Voorhees, NJ 08043-4512

Phone

(856) 751-0123

Fax

(856) 751-0535

NPI assigned

Jul 19, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Jersey Radiology Associates P a

  • Diagnostic Radiology Physician
  • Voorhees, NJ
  • NPI 1477551653
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338422400000",
    "number": "1902805286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1710",
            "address_2": "SOUTH JERSEY RADIOLOGY ASSOCIATES, PA",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080437710",
            "telephone_number": "856-770-0504",
            "fax_number": "856-770-0395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CARNIE BLVD",
            "address_2": "SUITE B-5",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434512",
            "telephone_number": "856-751-0123",
            "fax_number": "856-751-0535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNISI",
        "first_name": "ALFIO",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2012-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA04964700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON NJ HEALTH",
            "identifier": "1095010",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1243809",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0113270000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0695243",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1256904",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK PA BLUE SHIELD",
            "identifier": "PE524842",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIER BLUE",
            "identifier": "PE524842",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300047106",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH",
            "identifier": "A3738029",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna Marie Pellicori, AU.D.
• Meryl Penalver, NP
• Harini Pendem, MD
• Penn Valley Anesthesia Associates, LLC
• Penn Valley Anesthesia Associates, LLC
• Joeigh Anne Perella, DMD
• Robert Perelmut
• Francois Perera, MD
• Jessica Abigail Perez-Hernandez, LSW
• Adam Jay Perlin, OD

• Diagnostic Radiology Physician in Voorhees, NJ
• Providers in Voorhees, NJ by specialty
• Diagnostic Radiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.