1356309157 NPI number — RUVIM FALKOVICH MD

Table of content: RUVIM FALKOVICH MD (NPI 1356309157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356309157 NPI number — RUVIM FALKOVICH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALKOVICH
Provider First Name:
RUVIM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1356309157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 KINGS HIGHWAY SOUTH
Provider Second Line Business Mailing Address:
PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14617-5504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-922-1304
Provider Business Mailing Address Fax Number:
585-922-1399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 PORTLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14621-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-338-4941
Provider Business Practice Location Address Fax Number:
585-467-4626
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  203879 , 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)

  • Identifier: 050915000065 . This is a "FIDELIS CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00027282401 . This is a "UNIVERA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00355266 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101666DL . This is a "PREFERRED CARE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1214011 . This is a "IHA #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010203879 . This is a "BLUE CHOICE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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