Provider Demographics
NPI:1013224815
Name:CHENANGO DIAGNOSTIC IMAGING,PLLC
Entity type:Organization
Organization Name:CHENANGO DIAGNOSTIC IMAGING,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-334-7144
Mailing Address - Street 1:6 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1155
Mailing Address - Country:US
Mailing Address - Phone:607-334-7144
Mailing Address - Fax:607-334-7054
Practice Address - Street 1:6 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1155
Practice Address - Country:US
Practice Address - Phone:607-334-7144
Practice Address - Fax:607-334-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08021632261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology