Healthcare Provider Details

I. General information

NPI: 1508100140
Provider Name (Legal Business Name): SCHENECTADY RADIOLOGISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SITTERLY ROAD
CLIFTON PARK NY
12065
US

IV. Provider business mailing address

107 NOTT TERRACE SUITE 100
SCHENECTADY NY
12308
US

V. Phone/Fax

Practice location:
  • Phone: 518-579-2700
  • Fax: 518-372-2272
Mailing address:
  • Phone: 518-372-4405
  • Fax: 518-372-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number149212
License Number StateNY

VIII. Authorized Official

Name: GARY W. WOOD
Title or Position: RADIOLOGIST
Credential: MD
Phone: 518-372-4405