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General NPI Number Information
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NPI Number | 1508100140
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Entity Type | Organization
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Legal Business Name | SCHENECTADY RADIOLOGISTS, P.C.
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 103 SITTERLY ROAD
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City | CLIFTON PARK
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State | NY
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Zip | 12065
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Country | US
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Telephone | 518-579-2700
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Fax | 518-372-2272
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Provider Business Mailing Address
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Address Line | 107 NOTT TERRACE SUITE 100
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City | SCHENECTADY
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State | NY
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Zip | 12308
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Country | US
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Telephone | 518-372-4405
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Fax | 518-372-2272
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Authorized Official
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Title or Position | RADIOLOGIST
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Name | GARY W. WOOD
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Credential | MD
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Telephone | 518-372-4405
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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 | 149212
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License Number State | NY
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