Healthcare Provider Details

I. General information

NPI: 1063253482
Provider Name (Legal Business Name): LAKE CHAMPLAIN IMAGING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 STATE ROUTE 3
PLATTSBURGH NY
12901-6562
US

IV. Provider business mailing address

675 STATE ROUTE 3 STE 105
PLATTSBURGH NY
12901-6561
US

V. Phone/Fax

Practice location:
  • Phone: 518-572-6333
  • Fax:
Mailing address:
  • Phone: 518-699-9729
  • Fax: 518-699-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANTHONY G CONTI
Title or Position: MEMBER
Credential: M.D.
Phone: 518-572-6333