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General NPI Number Information
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NPI Number | 1326031725
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Entity Type | Organization
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Legal Business Name | MOHAWK VALLEY OPEN MRI, PC
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 1819 BLACK RIVER BLVD N
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City | ROME
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State | NY
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Zip | 13440-2427
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Country | US
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Telephone | 315-339-2671
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | ROME
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State | NY
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Zip | 13442-0669
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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 | DEPARTMENT HEAD
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Name | DR. LAWRENCE BURGREEN
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Credential | M.D.
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Telephone | 315-339-2671
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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 | 153927
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License Number State | NY
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