Healthcare Provider Details

I. General information

NPI: 1376805176
Provider Name (Legal Business Name): ADIRONDACK RADIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CARE LN SUITE 100
SARATOGA SPRINGS NY
12866-8639
US

IV. Provider business mailing address

PO BOX 985
GLENS FALLS NY
12801-0985
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-7773
  • Fax: 518-793-1976
Mailing address:
  • Phone: 518-793-1000
  • Fax: 518-793-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number163253
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDITH BERNARD
Title or Position: BILLING DIRECTOR
Credential:
Phone: 518-793-1000