Basic Information
| Provider Information | |||||||||
| NPI: | 1083615561 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KONIVER FISS MANSOORY MD PA | ||||||||
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| OtherOrganizationName: | PAPASTAVROS ASSOCIATES MEDICAL IMAGING LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 PITTSFORD VICTOR RD STE D | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145343825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852188012 | ||||||||
| FaxNumber: | 5852188099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 AUGUSTINE CUT OFF | ||||||||
| Address2: | BLDG. 4 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198034461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026523016 | ||||||||
| FaxNumber: | 3026522534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | SCOLA | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3026523016 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 1989029182 | DE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.