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General NPI Number Information
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NPI Number | 1235122425
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Entity Type | Organization
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Legal Business Name | PROSPECT HILL RADIOLOGY GROUP PC
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 301 PROSPECT AVE
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City | SYRACUSE
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State | NY
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Zip | 13203-1807
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Country | US
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Telephone | 315-448-5274
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Fax |
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Provider Business Mailing Address
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Address Line | 4567 CROSSROADS PARK DR 2ND FL
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City | LIVERPOOL
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State | NY
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Zip | 13088-3589
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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 | MEDICAL DIRECTOR
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Name | DR. ALAN FOSTER
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Credential | M.D.
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Telephone | 315-703-5119
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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 | 108725
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License Number State | NY
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