Provider Demographics
NPI:1063489060
Name:ASSOCIATED RADIOLOGISTS OF THE FINGER LAKES, P.C.
Entity Type:Organization
Organization Name:ASSOCIATED RADIOLOGISTS OF THE FINGER LAKES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:RAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-734-6237
Mailing Address - Street 1:100 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1318
Mailing Address - Country:US
Mailing Address - Phone:607-734-6237
Mailing Address - Fax:607-734-6158
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-734-3414
Practice Address - Fax:607-734-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCJ0402OtherPALMETTO GBA
NY00371971Medicaid
NYCJ0402OtherPALMETTO GBA