Provider Demographics
NPI:1588617625
Name:ASSOCIATES IN RADIOLOGY OF PLATTSBURGH NY PC
Entity Type:Organization
Organization Name:ASSOCIATES IN RADIOLOGY OF PLATTSBURGH NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WOLODYMYR
Authorized Official - Middle Name:I
Authorized Official - Last Name:BULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-562-3204
Mailing Address - Street 1:762 ROUTE 3
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7472
Mailing Address - Country:US
Mailing Address - Phone:518-562-3204
Mailing Address - Fax:518-563-0707
Practice Address - Street 1:762 ROUTE 3
Practice Address - Street 2:SUITE 14
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-7472
Practice Address - Country:US
Practice Address - Phone:518-562-3204
Practice Address - Fax:518-563-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCK0074OtherRAILROAD MEDICARE
NY00418382Medicaid
NYCK0074OtherRAILROAD MEDICARE