Basic Information
| Provider Information | |||||||||
| NPI: | 1275780587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHENECTADY RADIOLOGISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 NOTT TERRACE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183724405 | ||||||||
| FaxNumber: | 5183722272 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 NOTT STREET | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183828350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2008 | ||||||||
| LastUpdateDate: | 08/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | PAZIENZA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/RADIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5183724405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 176417 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 01322398 | 05 | NY | MEDICAID |