Provider Demographics
NPI:1285654863
Name:CLIFTON SPRINGS RAIOLOGY, PC
Entity Type:Organization
Organization Name:CLIFTON SPRINGS RAIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMP
Authorized Official - Suffix:
Authorized Official - Credentials:CCSP
Authorized Official - Phone:315-782-2620
Mailing Address - Street 1:1116 ARSENAL ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2229
Mailing Address - Country:US
Mailing Address - Phone:315-782-2620
Mailing Address - Fax:315-788-4980
Practice Address - Street 1:2 COULTER RD
Practice Address - Street 2:CLIFTON SPRINGS HOSPITAL
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432
Practice Address - Country:US
Practice Address - Phone:315-782-2620
Practice Address - Fax:315-788-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID