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NPI Code Detail

MEDICARE: LAKES RADIOLOGY PLLC

MEDICARE: LAKES RADIOLOGY PLLC
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
12085R0202XDiagnostic Radiology Physician167192NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000914685002OTHERNYHEALTHNOW
3G0187663370OTHERNYBCBS OF CNY

General Provider Information

NPI Number : 1710937727
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKES RADIOLOGY PLLC
Provider Business Mailing Address
First Line : 7 ERIE AVE
Second Line : RADIOLOGY
City : HORNELL
State : NY
Zip : 14843-1909
Country : US
Telephone Number : 607-324-8255
Fax Number : 607-324-8774
Provider Business Practice Location Address
First Line : 411 CANISTEO ST
Second Line : RADIOLOGY
City : HORNELL
State : NY
Zip : 14843-2104
Country : US
Telephone Number : 607-324-8255
Fax Number : 607-324-8774
Authorized Official
Title or Position : CEO
Name : DR. IDDO NETANYAHU
Credential : MD
Telephone Number : 607-324-8255
Provider Enumeration Date : 05/11/2006
Last Update Date : 02/04/2011

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