Organization
JUNIPER RADIOLOGY, PC
Active
Organization
JUNIPER RADIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK FENZL MD (PRESIDENT)
(716) 649-1722
Entity
Organization
Contact information
Practice address
224 E MAIN ST, SPRINGVILLE, NY 14141-1443
(716) 592-2871
Mailing address
PO BOX 1314, ORCHARD PARK, NY 14127-8314
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02872008
—
NY
01
—
GRP529117001
BCBS WESTERN NY
NY
Enumeration date
04/04/2007
Last updated
04/23/2020
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