Provider Demographics
NPI:1083615561
Name:KONIVER FISS MANSOORY MD PA
Entity Type:Organization
Organization Name:KONIVER FISS MANSOORY MD PA
Other - Org Name:PAPASTAVROS ASSOCIATES MEDICAL IMAGING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-652-3016
Mailing Address - Street 1:1160 PITTSFORD VICTOR RD STE D
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3825
Mailing Address - Country:US
Mailing Address - Phone:585-218-8012
Mailing Address - Fax:585-218-8099
Practice Address - Street 1:1701 AUGUSTINE CUT OFF
Practice Address - Street 2:BLDG. 4
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-4461
Practice Address - Country:US
Practice Address - Phone:302-652-3016
Practice Address - Fax:302-652-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19890291822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty