NPIMap

Organization Active NPI

Park Avenue Associates in Radiology PC

  • Diagnostic Radiology Physician
  • Johnson City, NY
National Provider Identifier
1760447692
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PARK AVENUE ASSOCIATES IN RADIOLOGY PC
Practice address
32-36 Harrison St
Johnson City, NY 13790-2122
Phone
(607) 763-6104
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2020

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

Authorized official

Name
Dr. Edward Santelli
Title
President
Phone
(607) 729-2125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

32-36 Harrison St
Johnson City, NY 13790-2122

Mailing address

PO Box 23
Canajoharie, NY 13317-0023
Phone (315) 362-5285

Other identifiers 1

IdentifierTypeStateIssuer
00553397MedicaidNY

Other names 1

  • Southern Tier Imaging Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MA, PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040716001034 NY Part B Supplier - Clinic/Group Practice 3971582594 Receives reassigned benefits from 10 practitioners
Practice locations: Brooklyn, NY; Norwich, NY; Johnson City, NY
O20161019001661 MA Part B Supplier - Clinic/Group Practice 3971582594 Receives reassigned benefits from 1 practitioner
Practice locations: Osterville, MA
O20231003002560 PA Part B Supplier - Clinic/Group Practice 3971582594 Receives reassigned benefits from 2 practitioners
Practice locations: Mars, PA; Warminster, PA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

65 Pennsylvania Ave
#205
Binghamton, NY 13903
Phone (607) 762-2243

81 Chenango BRG Rd
Binghamton, NY 13901
Phone (305) 441-2144

32-36 Harrison St
Johnson City, NY 13790
Phone (607) 217-1021

52 Harrison St
Johnson City, NY 13790
Phone (607) 729-8845

30 Harrison St
Ste 102
Johnson City, NY 13790
Phone (607) 729-7082

42 W Main St
Owego, NY 13827
Phone (607) 687-0350

4417 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 729-2144

4433 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 762-2176

4421 Vestal Pkwy E
Vestal, NY 13850
Phone (607) 798-1234

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1760447692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23",
            "city": "CANAJOHARIE",
            "state": "NY",
            "postal_code": "133170023",
            "telephone_number": "315-362-5285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32-36 HARRISON ST",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902122",
            "telephone_number": "607-763-6104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE ASSOCIATES IN RADIOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "SANTELLI",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "607-729-2125",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00553397",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Tier Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Tier Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; 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.