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General NPI Number Information
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NPI Number | 1710941901
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD DIAGNOSTIC IMAGING
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 ERIE CANAL DR
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City | ROCHESTER
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State | NY
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Zip | 14626-4607
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Country | US
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Telephone | 585-723-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 790 LINDEN AVE
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City | ROCHESTER
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State | NY
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Zip | 14625-2716
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Country | US
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Telephone | 585-385-9030
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Fax | 585-385-9124
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAMAL KOTHARI
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Credential | MD
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Telephone | 585-723-0111
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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 | 141316
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License Number State | NY
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