Provider Demographics
NPI:1508859620
Name:WELLSVILLE RADIOLOGY, PLLC
Entity Type:Organization
Organization Name:WELLSVILLE RADIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AYYUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-593-1100
Mailing Address - Street 1:601 GATES RD
Mailing Address - Street 2:STE 3
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2288
Mailing Address - Country:US
Mailing Address - Phone:607-772-9462
Mailing Address - Fax:607-772-1223
Practice Address - Street 1:191 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1150
Practice Address - Country:US
Practice Address - Phone:585-593-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1344752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty