Healthcare Provider Details

I. General information

NPI: 1497019970
Provider Name (Legal Business Name): IMAGING SERVICES OF WESTERN NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222-224 E MAIN ST
SPRINGVILLE NY
14141-1443
US

IV. Provider business mailing address

200 INTERNATIONAL DR
WILLIAMSVILLE NY
14221-8217
US

V. Phone/Fax

Practice location:
  • Phone: 716-592-2871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: RICHARD THOMAS
Title or Position: PRESIDENT
Credential:
Phone: 716-592-2871