MOHAWK GLEN RADIOLOGY ASSOCIATES OF CNY PLLC (NPI# 1538466115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538466115 |
| Entity Type | Organization |
| Organization Name | MOHAWK GLEN RADIOLOGY ASSOCIATES OF CNY PLLC |
| Practice Address |
91 Perimeter Rd Suite 110 Rome NY 13441-4018 |
| Mailing Address |
Po Box 394 Canajoharie NY 13317-0394 |
| Practice Telephone | 3153349729 |
| Practice Fax Number | 3153341185 |
| Mailing Telephone | 3153397965 |
| Mailing Fax Number | 8142351566 |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2019-03-04 |
| Authorized Official Name | PHILIP J FRACCOLA (AUTHORIZED SIGNER) |
| Authorized Official Telephone | 3153823031 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03387708 | 05 |
| Street Address |
91 PERIMETER RD SUITE 110 |
| City | ROME |
| State | NY |
| Zip Code | 13441-4018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992702666 | Susan M Grove | Nurse Practitioner | 91 Perimeter Rd, Suite 120, Rome, NY 13441-4018 | 2005-07-07 |
| 1194181073 | Shannon Haggerty | Hearing Instrument Specialist | 91 Perimeter Rd, Suite 180, Rome, NY 13441-4018 | 2016-01-08 |
| 1700254448 | Here We Are | Specialist | 91 Perimeter Rd, Suite 180, Rome, NY 13441-4018 | 2015-09-11 |
| 1730521964 | Kathleen Grabo Pallay | Nurse Practitioner | 91 Perimeter Rd, Rome, NY 13441 | 2013-07-30 |
| 1144355132 | Mohawk Glen Urgent Care, Pllc | Clinic/Center | 91 Perimeter Rd, Suite 100, Rome, NY 13441-4018 | 2007-02-22 |
| 1629119839 | Carolyn A Cole | Nurse Practitioner | 91 Perimeter Rd, Suite 120, Rome, NY 13441-4018 | 2007-02-09 |
| 1639244692 | Lafountain Chiropractic Center | Chiropractor | 91 Perimeter Rd, Suite 130, Rome, NY 13440 | 2006-11-22 |
| 1598851545 | Faxton-st. Lukes Healthcare | Clinic/Center | 91 Perimeter Rd, Ste. 140, Rome, NY 13441 | 2006-10-05 |
| 1902999865 | Jeffery Scott Roy | Physician Assistant | 91 Perimeter Rd, Suite 100, Rome, NY 13441-4018 | 2006-10-02 |
| 1194746354 | Mohawk Glen Family Practice Pllc | Family Medicine | 91 Perimeter Rd, Suite 120, Rome, NY 13441-4018 | 2006-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831484567 | Griffiss Ec, LLC | Clinic/Center | 105 Dart Circle, Rome, NY 13441 | 2011-06-10 |
| 1437328713 | Duane Leo Wallace | Dentist | 63 Geiger Road, Rome, NY 13441 | 2008-02-21 |
| 1316008311 | Upstate Cerebral Palsy, Inc | Intermediate Care Facility, Mentally Retarded | 124 Brookley Road, Crp #7, Rome, NY 13441 | 2006-12-13 |
| 1821102161 | Nicholas S Peters | Internal Medicine | 267 Hill Road, Suite 200, Rome, NY 13441 | 2006-08-17 |
| 1396769048 | Judy Norman Wilburn | Nurse Practitioner | Rome Cboc of The Syracuse Va, 125 Brookley Ave., Rome, NY 13441 | 2006-07-26 |
| 1275590408 | Antonietta Luisi | Optometrist | 125 Brookley Road, Rome, NY 13441 | 2006-05-01 |
| 1851822175 | Elizabeth C Santaniello | Nurse Practitioner | 267 Hill Rd, Rome, NY 13441 | 2017-03-27 |
| 1316208002 | Robert Firth Pickels Jr. | Surgery | 267 Hill Road, Rome, NY 13441 | 2012-05-30 |
| 1609937697 | Upstate Cerebral Palsy, Inc | Intermediate Care Facility, Mentally Retarded | 126 Brookley Road, Rome, NY 13441-0000 | 2006-12-13 |
| 1578874582 | Nicole Dmitri Kekis | Physical Therapist | 130 Brookley Rd., Rome, NY 13441-2530 | 2010-06-24 |
| Find all providers in zip 13441 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750539177 | Louis Hamilton Vanslyke | Radiology | 6765 Golf Course Rd, Rome, NY 13440-7547 | 2008-08-28 |
| 1609034388 | James M Terzian | Radiology | 901 N Broad St Ne Ste 120, Rome, GA 30161-5202 | 2008-05-29 |
| 1922084474 | Eddie Salvatore Fiore | Radiology | Via Cortina D'ampezzo 57, Rome, NOT APPLICABLE 00135 | 2005-12-16 |
| 1013356740 | Constantinos Theodoros Spyris | Radiology | 901 N Broad St Ne Ste 120, Rome, GA 30161-5202 | 2013-06-15 |
| 1578880308 | Adams W Moore | Radiology | 901 N Broad St Ne, Suite 220, Rome, GA 30161-5201 | 2010-05-04 |
| 1679751606 | Daniel Gober | Radiology | 901 N Broad St Ne, Suite 220, Rome, GA 30161-5201 | 2008-01-31 |
| 1922299957 | Michael Paul Holcombe | Radiology | 901 N Broad St Ne, Suite 220, Rome, GA 30161-5207 | 2007-08-06 |
| 1265564975 | Rome Mri Associates | Radiology | 1819 Black River Blvd N, Rome, NY 13440-2427 | 2007-03-09 |
| 1801838867 | Matthew B Mcclain | Radiology | 255 W 5th St Sw, Suite 150, Rome, GA 30165-2817 | 2006-06-12 |
| 1326031725 | Mohawk Valley Open Mri, PC | Radiology | 1819 Black River Blvd N, Rome, NY 13440-2427 | 2005-08-31 |
| Find all providers in ROME | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.