Individual
MR. RANDY L NIBLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2209 GENESEE STREET, UTICA, NY 13501-5930
(315) 798-8171
(315) 734-3064
Mailing address
4567 CROSSROADS PARK DRIVE, LIVERPOOL, NY 13088-3589
(315) 295-2100
(315) 295-2125
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
24386
OK
2085R0202X
Diagnostic Radiology Physician
Primary
262720
NY
2085R0202X
Diagnostic Radiology Physician
ME171857
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200057370A
—
OK
01
—
248523231
MEDICARE
OK
01
—
P000274709
RAILROAD MEDICARE
OK
Enumeration date
11/21/2005
Last updated
01/28/2025
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