NPIMap

Organization Active NPI

Southern Tier Psychiatry PLLC

  • Psychiatry Physician
  • Vestal, NY
National Provider Identifier
1083466353
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
SOUTHERN TIER PSYCHIATRY PLLC
Practice address
1500 Vestal Pkwy E Ste 102
Vestal, NY 13850-1831
Phone
(315) 403-4271
NPI assigned
Apr 2, 2024
Last updated
Apr 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Viral Goradia, MDNPI 1871880989
Title
Psychiatrist
Phone
(315) 403-4271

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

1500 Vestal Pkwy E Ste 102
Vestal, NY 13850-1831

Mailing address

3439, Vestal Parkway E
Ste 2, Num 197
Vestal, NY 13850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240521002645 NY Part B Supplier - Clinic/Group Practice 4587006697 Receives reassigned benefits from 9 practitioners
Practice locations: Vestal, NY

National Provider Directory

National Provider Directory

Locations

1500 Vestal Pkwy E
Ste 102
Vestal, NY 13850
Phone (607) 307-5015

3439 Vestal Pkwy E
#2
Vestal, NY 13850

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1083466353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3439, VESTAL PARKWAY E",
            "address_2": "STE 2, NUM 197",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "13850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 VESTAL PKWY E STE 102",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138501831",
            "telephone_number": "315-403-4271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN TIER PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "GORADIA",
        "authorized_official_first_name": "VIRAL",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "315-403-4271",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vestal, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.