Provider Demographics
NPI:1548253446
Name:ADVANCED RADIOLOGY SERVICES, PLLC
Entity type:Organization
Organization Name:ADVANCED RADIOLOGY SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MARKE
Authorized Official - Last Name:CADKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-798-5298
Mailing Address - Street 1:5 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-2322
Mailing Address - Country:US
Mailing Address - Phone:607-772-9462
Mailing Address - Fax:607-772-1223
Practice Address - Street 1:169 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-798-5223
Practice Address - Fax:607-798-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02220515Medicaid
NY02220515Medicaid