Healthcare Provider Details

I. General information

NPI: 1164465217
Provider Name (Legal Business Name): HERKIMER-LITTLE FALLS RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LITTLE FALLS HOSPITAL 140 BURWELL ST
LITTLE FALLS NY
13365
US

IV. Provider business mailing address

116 ARSENAL ST SUITE 504
WATERTOWN NY
13601-2520
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-2620
  • Fax: 315-788-4980
Mailing address:
  • Phone: 315-782-2620
  • Fax: 315-788-4980

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: CHRISTINE CRUMP
Title or Position: HIPAA COMPLIANCE OFFICER
Credential: CCSP
Phone: 315-782-2620