Provider Demographics
NPI:1952442519
Name:CANANDAIGUA MEDICAL GROUP X-RAY
Entity Type:Organization
Organization Name:CANANDAIGUA MEDICAL GROUP X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CHRM
Authorized Official - Phone:585-393-2888
Mailing Address - Street 1:335 PARRISH ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1728
Mailing Address - Country:US
Mailing Address - Phone:585-393-2888
Mailing Address - Fax:585-396-9275
Practice Address - Street 1:335 PARRISH ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1728
Practice Address - Country:US
Practice Address - Phone:585-393-2888
Practice Address - Fax:585-396-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34005413261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD777TOtherPREFERRED CARE
NYP0100XRCMGOtherBLUE CHOICE