Healthcare Provider Details

I. General information

NPI: 1235145053
Provider Name (Legal Business Name): ADIRONDACK DIAGNOSTIC IMAGING OF ALBANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WASHINGTON AVE
ALBANY NY
12206-1098
US

IV. Provider business mailing address

632 PLANK RD SUITE 103
CLIFTON PARK NY
12065-2019
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-4838
  • Fax: 518-482-8235
Mailing address:
  • Phone: 518-373-2121
  • Fax: 518-373-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D GREEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 518-373-2121