Basic Information
Provider Information | |||||||||
NPI: | 1023075165 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RINALDI | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 199 PARK CLUB LN STE 300 | ||||||||
Address2: |   | ||||||||
City: | WILLIAMSVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 142215269 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168364646 | ||||||||
FaxNumber: | 7168364696 | ||||||||
Practice Location | |||||||||
Address1: | 199 PARK CLUB LN STE 300 | ||||||||
Address2: |   | ||||||||
City: | WILLIAMSVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 142215269 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168364646 | ||||||||
FaxNumber: | 7168364696 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2006 | ||||||||
LastUpdateDate: | 12/17/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/17/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 232173 | NY | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 00026878505 | 01 |   | UNIVERA | OTHER | 040810000105 | 01 |   | FIDELIS | OTHER | 000527712001 | 01 |   | BLUE SHIELD WNY | OTHER | 000527712009 | 01 |   | BLUE SHIELD WNY | OTHER | P040232173 | 01 |   | BLUE SHIELD ROCHESTER | OTHER | P00134032 | 01 |   | RR MEDICARE | OTHER | 0142863 | 01 |   | GHI | OTHER | 4194030 | 01 |   | GHI | OTHER | P00144750 | 01 |   | RR MEDICARE | OTHER | P010232173 | 01 |   | BLUE CHOICE | OTHER | P020232173 | 01 |   | BLUE SHIELD ROCHESTER | OTHER | 00026878507 | 01 |   | UNIVERA | OTHER | 000527712007 | 01 |   | BLUE SHIELD WNY | OTHER | 195342FF | 01 |   | PREFERRED CARE | OTHER | 2321735B | 01 | NY | WORKERS COMPENSATION | OTHER | 00026878502 | 01 |   | UNIVERA | OTHER | 02558565 | 05 | NY |   | MEDICAID | 1612549 | 01 |   | INDEPENDENT HEALTH | OTHER |