Provider Demographics
NPI:1083466353
Name:SOUTHERN TIER PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:SOUTHERN TIER PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-403-4271
Mailing Address - Street 1:3439, VESTAL PARKWAY E
Mailing Address - Street 2:STE 2, NUM 197
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 VESTAL PKWY E STE 102
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1831
Practice Address - Country:US
Practice Address - Phone:315-403-4271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty