Organization
MOHAWK GLEN RADIOLOGY ASSOCIATES OF CNY PLLC
Active
Organization
MOHAWK GLEN RADIOLOGY ASSOCIATES OF CNY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP J FRACCOLA MD (AUTHORIZED SIGNER)
(315) 382-3031
Entity
Organization
Contact information
Practice address
91 PERIMETER RD, SUITE 110, ROME, NY 13441-4018
(315) 334-9729
(315) 334-1185
Mailing address
PO BOX 394, CANAJOHARIE, NY 13317-0394
(315) 339-7965
(814) 235-1566
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03387708
—
NY
Enumeration date
02/17/2011
Last updated
03/04/2019
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