1295244309 NPI number — COMPREHENSIVE MEDICINE, PLLC

Table of content: ERICA DENISE ROCHE DIKE RBT (NPI 1093539355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295244309 NPI number — COMPREHENSIVE MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE MEDICINE, PLLC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Middle Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1295244309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 DUFFIELD ROAD;
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-721-4648
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
762 CROSSKEYS OFFICE PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-721-4648
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAUDHRI
Authorized Official First Name:
YASHWANT
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
585-721-4648

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  207020-1 , 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)