Healthcare Provider Details

I. General information

NPI: 1225093867
Provider Name (Legal Business Name): CNY DIAGNOSTIC IMAGING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E GENESEE ST SUITE 100
SYRACUSE NY
13210-1892
US

IV. Provider business mailing address

1000 E GENESEE ST SUITE 100
SYRACUSE NY
13210-1892
US

V. Phone/Fax

Practice location:
  • Phone: 315-269-9729
  • Fax: 315-476-3712
Mailing address:
  • Phone: 315-472-8835
  • Fax: 315-476-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK J LYNCH
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 315-472-8835