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General NPI Number Information
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NPI Number | 1174743173
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Entity Type | Organization
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Legal Business Name | NORTHERN CHAUTAUQUA RADIOLOGY LLC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 189 E MAIN ST
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City | WESTFIELD
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State | NY
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Zip | 14787-1104
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Country | US
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Telephone | 716-363-9342
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 110
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City | FREDONIA
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State | NY
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Zip | 14063-0110
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Country | US
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Telephone | 716-363-6342
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Fax | 716-363-6345
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JON A MUNTZ
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Credential | MD
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Telephone | 716-363-6342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | 185798
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License Number State | NY
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