Provider Demographics
NPI:1538494521
Name:ON SITE IMAGING INC
Entity Type:Organization
Organization Name:ON SITE IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:315-733-8393
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-0029
Mailing Address - Country:US
Mailing Address - Phone:315-733-8393
Mailing Address - Fax:
Practice Address - Street 1:14 KRAFT DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:NY
Practice Address - Zip Code:13502-1126
Practice Address - Country:US
Practice Address - Phone:315-733-8393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239674335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03109395Medicaid
NY03109395Medicaid