Healthcare Provider Details

I. General information

NPI: 1992827729
Provider Name (Legal Business Name): JUNIPER RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E MAIN ST
SPRINGVILLE NY
14141-1443
US

IV. Provider business mailing address

PO BOX 1314
ORCHARD PARK NY
14127-8314
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: MARK FENZL
Title or Position: PRESIDENT
Credential: MD
Phone: 716-649-1722