1144366147 NPI number — SIDNEY HILLMAN HEALTH CNTR OF ROCHESTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144366147 NPI number — SIDNEY HILLMAN HEALTH CNTR OF ROCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIDNEY HILLMAN HEALTH CNTR OF ROCHESTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SIDNEY HILLMAN HEALTH CNTR OPTICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144366147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 EAST AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14607-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-271-1911
Provider Business Mailing Address Fax Number:
585-442-7216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 EAST AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14607-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-271-1911
Provider Business Practice Location Address Fax Number:
585-442-7216
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIDEBOTHAM
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
MANAGING OPTICIAN
Authorized Official Telephone Number:
585-271-1911

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  C003607-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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