Provider Demographics
NPI:1750370805
Name:NORTHERN RADIOLOGY IMAGING CENTER, PLLC
Entity type:Organization
Organization Name:NORTHERN RADIOLOGY IMAGING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BISIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-786-5047
Mailing Address - Street 1:1571 WASHINGTON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-786-5046
Mailing Address - Fax:315-786-5043
Practice Address - Street 1:120 WASHINGTON ST STE 406
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3330
Practice Address - Country:US
Practice Address - Phone:315-786-5047
Practice Address - Fax:315-786-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID #