Healthcare Provider Details

I. General information

NPI: 1477821254
Provider Name (Legal Business Name): SOUTH UTICA DIGITAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 GENESEE ST SUITE 103
UTICA NY
13501-6222
US

IV. Provider business mailing address

2709 GENESEE ST SUITE 103
UTICA NY
13501-6222
US

V. Phone/Fax

Practice location:
  • Phone: 315-797-1908
  • Fax: 315-797-1193
Mailing address:
  • Phone: 315-797-1908
  • Fax: 315-797-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberX010285
License Number StateNY

VIII. Authorized Official

Name: DR. TIMOTHY JOSEPH DELMEDICO
Title or Position: PRESIDENT
Credential: DC
Phone: 315-797-1908