=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902879141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHENECTADY RADIOLOGISTS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 08/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2546 BALLTOWN RD SUITE 100
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12309-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-372-1344
-----------------------------------------------------
Fax | 518-372-9848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 NOTT TER SUITE 100
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12308-3170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-372-4405
-----------------------------------------------------
Fax | 518-372-2272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RADIOLOGIST
-----------------------------------------------------
Name | DR. MICHAEL L BURKE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 518-372-4405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 156431
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------