Basic Information
| Provider Information | |||||||||
| NPI: | 1912949314 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER RADIOLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2270 | ||||||||
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| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124022270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453397582 | ||||||||
| FaxNumber: | 8453385616 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 PINE GROVE AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453404500 | ||||||||
| FaxNumber: | 8453404501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARTZ | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | RADIOLOGIST/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8453404500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 261QR0200X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 01896244 | 05 | NY | MEDICAID |