Healthcare Provider Details

I. General information

NPI: 1003864745
Provider Name (Legal Business Name): FINGER LAKES RADIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MASON ST
GENEVA NY
14456-1133
US

IV. Provider business mailing address

PO BOX 8000 DEPT. 044
BUFFALO NY
14267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5399
  • Fax: 315-787-5391
Mailing address:
  • Phone: 716-692-2160
  • Fax: 716-213-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAMANI RAO
Title or Position: PARTNER
Credential: MD
Phone: 315-787-5399