Provider Demographics
NPI:1114975729
Name:ACADEMIC MEDICAL IMAGING, PC
Entity Type:Organization
Organization Name:ACADEMIC MEDICAL IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RULING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-433-1766
Mailing Address - Street 1:114 SOUTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3256
Mailing Address - Country:US
Mailing Address - Phone:607-433-1766
Mailing Address - Fax:607-433-2058
Practice Address - Street 1:114 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3256
Practice Address - Country:US
Practice Address - Phone:607-433-1766
Practice Address - Fax:607-433-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0848Medicare ID - Type Unspecified