Provider Demographics
NPI:1831196054
Name:MAGNETIC DIAGNOSTIC RESOURCES OF CENTRAL NEW YORK, LLP
Entity type:Organization
Organization Name:MAGNETIC DIAGNOSTIC RESOURCES OF CENTRAL NEW YORK, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-362-5129
Mailing Address - Street 1:5000 BRITTONFIELD PKWY STE A114
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9228
Mailing Address - Country:US
Mailing Address - Phone:315-454-4810
Mailing Address - Fax:315-362-5285
Practice Address - Street 1:5000 BRITTONFIELD PKWY STE A114
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9228
Practice Address - Country:US
Practice Address - Phone:315-454-4810
Practice Address - Fax:315-299-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02291532Medicaid
NY52017AOtherMEDICARE ID NUMBER
NY52017AOtherMEDICARE ID NUMBER