Provider Demographics
NPI:1710937727
Name:LAKES RADIOLOGY PLLC
Entity Type:Organization
Organization Name:LAKES RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IDDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NETANYAHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-324-8255
Mailing Address - Street 1:7 ERIE AVE
Mailing Address - Street 2:RADIOLOGY
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1909
Mailing Address - Country:US
Mailing Address - Phone:607-324-8255
Mailing Address - Fax:607-324-8774
Practice Address - Street 1:411 CANISTEO ST
Practice Address - Street 2:RADIOLOGY
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2104
Practice Address - Country:US
Practice Address - Phone:607-324-8255
Practice Address - Fax:607-324-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1671922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02412119Medicaid
NY000914685002OtherHEALTHNOW
NYG0187663370OtherBCBS OF CNY
NY000914685002OtherHEALTHNOW