Provider Demographics
NPI:1902879141
Name:SCHENECTADY RADIOLOGISTS, P.C.
Entity Type:Organization
Organization Name:SCHENECTADY RADIOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-372-4405
Mailing Address - Street 1:107 NOTT TER
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-3170
Mailing Address - Country:US
Mailing Address - Phone:518-372-4405
Mailing Address - Fax:518-372-2272
Practice Address - Street 1:2546 BALLTOWN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1079
Practice Address - Country:US
Practice Address - Phone:518-372-1344
Practice Address - Fax:518-372-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01149348Medicaid
NY38648EMedicare ID - Type Unspecified
NY01149348Medicaid