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General NPI Number Information
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NPI Number | 1164465217
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Entity Type | Organization
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Legal Business Name | HERKIMER-LITTLE FALLS RADIOLOGY PC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | LITTLE FALLS HOSPITAL 140 BURWELL ST
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City | LITTLE FALLS
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State | NY
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Zip | 13365
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Country | US
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Telephone | 315-782-2620
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Fax | 315-788-4980
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Provider Business Mailing Address
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Address Line | 116 ARSENAL ST SUITE 504
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City | WATERTOWN
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State | NY
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Zip | 13601-2520
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Country | US
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Telephone | 315-782-2620
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Fax | 315-788-4980
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Authorized Official
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Title or Position | HIPAA COMPLIANCE OFFICER
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Name | CHRISTINE CRUMP
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Credential | CCSP
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Telephone | 315-782-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | NY
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