MEDICARE: ADIRONDACK DIAGNOSTIC IMAGING OF QUEENSBURY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1114933934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADIRONDACK DIAGNOSTIC IMAGING OF QUEENSBURY

Provider Business Mailing Address
First Line	:	632 PLANK RD
Second Line	:	SUITE 103
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-2019
Country	:	US
Telephone Number	:	518-373-2121
Fax Number	:	518-373-1762

Provider Business Practice Location Address
First Line	:	375 BAY RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-3012
Country	:	US
Telephone Number	:	518-792-1700
Fax Number	:	518-792-1711

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL D. GREEN
Credential	:	M.D.
Telephone Number	:	518-373-2121

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	12/10/2008

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