| Southern Tier Psychiatry Pllc | |
|
1500 Vestal Pkwy E Ste 102 Vestal NY 13850-1831 | |
| (315) 403-4271 | |
| Not Available |
| Full Name | Southern Tier Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1500 Vestal Pkwy E Ste 102, Vestal, New York |
| Authorized Official Name and Position | Viral Goradia (PSYCHIATRIST) |
| Authorized Official Contact | 3154034271 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Tier Psychiatry Pllc 3439, Vestal Parkway E Ste 2, Num 197 Vestal NY 13850 Ph: () - | Southern Tier Psychiatry Pllc 1500 Vestal Pkwy E Ste 102 Vestal NY 13850-1831 Ph: (315) 403-4271 |
| NPI Number | 1083466353 |
|---|---|
| Provider Enumeration Date | 04/02/2024 |
| Last Update Date | 04/02/2024 |
| Certification Date | 04/02/2024 |
| Medicare PECOS PAC ID | 4587006697 |
|---|---|
| Medicare Enrollment ID | O20240521002645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083466353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Viral V Goradia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871880989 PECOS PAC ID: 1557648185 Enrollment ID: I20170508001560 |
| Provider Name | Purushothaman Muthukanagaraj |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083902399 PECOS PAC ID: 2567751142 Enrollment ID: I20191022000159 |
| Provider Name | Joy A Roselle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770192163 PECOS PAC ID: 0042623696 Enrollment ID: I20201229000435 |
| Provider Name | Amanda Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386420644 PECOS PAC ID: 9133578602 Enrollment ID: I20231208001712 |
| Provider Name | Maanvi Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548658545 PECOS PAC ID: 4688926496 Enrollment ID: I20240219002263 |
| Provider Name | Julie Dorber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306687314 PECOS PAC ID: 9537605753 Enrollment ID: I20240724002789 |
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