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NPI Code Detail

MEDICARE: ADIRONDACK ADVANCE IMAGING LLC

MEDICARE: ADIRONDACK ADVANCE IMAGING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0200XRadiology Clinic/Center
2261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number : 1588967483
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADIRONDACK ADVANCE IMAGING LLC
Provider Business Mailing Address
First Line : 375 BAY RD
Second Line : SUITE 101
City : QUEENSBURY
State : NY
Zip : 12804-3012
Country : US
Telephone Number : 518-409-8811
Fax Number : 518-409-8814
Provider Business Practice Location Address
First Line : 375 BAY RD
Second Line : SUITE 101
City : QUEENSBURY
State : NY
Zip : 12804-3012
Country : US
Telephone Number : 518-409-8811
Fax Number : 518-409-8814
Authorized Official
Title or Position : OWNER
Name : AJAY GOYAL
Credential : M.D.
Telephone Number : 518-409-8811
Provider Enumeration Date : 12/15/2010
Last Update Date : 08/13/2014

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Directions to “ADIRONDACK ADVANCE IMAGING LLC ” Practice Location

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