Basic Information
| Provider Information | |||||||||
| NPI: | 1750370805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN RADIOLOGY IMAGING CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1571 WASHINGTON STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157865046 | ||||||||
| FaxNumber: | 3157865043 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 WASHINGTON ST STE 406 | ||||||||
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| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136013330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157865047 | ||||||||
| FaxNumber: | 3157865010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | BISIG | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3157865047 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.