Seaway Radiology PC
Organization Active NPI Diagnostic Radiology Physician · Alexandria Bay, NY
NPI 1124012018 · NPPES record last updated Apr 9, 2024
Key facts
- NPI
- 1124012018
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 198556 (NY)
- Legal business name
- SEAWAY RADIOLOGY PC
- Practice address
- 4 Fuller St
Alexandria Bay, NY 13607-1316 - Phone
- (315) 482-2511
- NPI assigned
- Sep 7, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Ali M Gharagozloo, M.D.
- Title
- Medical Director of Group
- Phone
- (315) 393-1215
Practitioners 18
-
Abbas A Chamsuddin, M.D.
-
Steven J Dileo, MD
-
Jerald D Hansing, MD
-
Pradheep J Shanker, M.D.
-
Michael Yuz, M.D.
-
Thomas G Green, MD
-
Mark Kwalbrun, MD
-
Maximina Boutselis, M.D.
-
Dennis M Burton, M.D.
-
Aamer Z. Farooki, M.D.
-
John Joseph Wasenko, M.D.
-
Lloyd David Wagner, M.D.
-
Jeffrey J Buran, MD
-
Susanne Daye, MD
-
Walter C Silbert, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (9 enrollments) in NY, CA, NC, OH, MA, FL, PA, CO, AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040518001496 | NY | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 6 practitioners Practice locations: Alexandria Bay, NY; Ithaca, NY; Jericho, NY; Watertown, NY |
| O20150829000189 | CA | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 1 practitioner Practice locations: Santa Monica, CA |
| O20201015002109 | NC | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 1 practitioner Practice locations: Saluda, NC |
| O20230502001288 | OH | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 2 practitioners Practice locations: Portsmouth, OH; Dublin, OH |
| O20230505002001 | MA | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 1 practitioner Practice locations: Newburyport, MA |
| O20230508000975 | FL | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 3 practitioners Practice locations: Fort Lauderdale, FL; Palm City, FL; Port St Lucie, FL |
| O20230508001130 | PA | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 1 practitioner Practice locations: Phoenixville, PA |
| O20240124000167 | CO | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 1 practitioner Practice locations: Colorado Springs, CO |
| O20240731000491 | AZ | Part B Supplier - Clinic/Group Practice | 6305837584 |
Receives reassigned benefits from 1 practitioner Practice locations: Cave Creek, AZ |
National Provider Directory
Locations
344 S Warren St
#610
Syracuse, NY 13202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | 198556 | NY | Yes |
Addresses
Primary practice location
4 Fuller St
Alexandria Bay, NY 13607-1316
Mailing address
27 Dockside Dr # 27
Morristown, NY 13664-3231
Phone (315) 482-2511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02728623 | Medicaid | NY |
Other providers in Alexandria Bay, NY
- Crystal Rowley
- Edward J Ryan
- Molly Ryan
- Amanda Rydberg
- Deborah Walldroff Schryver
- Sharon Lynn Segouin
- Natalie Anne Shea
- Cynthia Lee Simpson
- Jessica Michelle Smith
- Tyree Bernard Smith
All providers in Alexandria Bay, NY · Diagnostic Radiology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.