Provider Demographics
NPI:1467735084
Name:ONTARIO RADIOLOGY PLLC
Entity Type:Organization
Organization Name:ONTARIO RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAKTASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTORABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-462-9561
Mailing Address - Street 1:405 N FRENCH RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2010
Mailing Address - Country:US
Mailing Address - Phone:716-689-1901
Mailing Address - Fax:716-564-0209
Practice Address - Street 1:2 COULTER RD
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:716-689-1901
Practice Address - Fax:716-564-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty