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General NPI Number Information
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NPI Number | 1083466353
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Entity Type | Organization
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Legal Business Name | SOUTHERN TIER PSYCHIATRY PLLC
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 1500 VESTAL PKWY E STE 102
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City | VESTAL
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State | NY
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Zip | 13850-1831
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Country | US
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Telephone | 315-403-4271
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Fax |
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Provider Business Mailing Address
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Address Line | 3439, VESTAL PARKWAY E STE 2, NUM 197
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City | VESTAL
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State | NY
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Zip | 13850
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. VIRAL GORADIA
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Credential | MD
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Telephone | 315-403-4271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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