1508100355 NPI number — GREATER ROCHESTER BREAST SURGERY

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 1508100355 NPI number — GREATER ROCHESTER BREAST SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER ROCHESTER BREAST SURGERY
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:
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:
1508100355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2235 CLINTON AVE S
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:
14618-2623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-454-6720
Provider Business Mailing Address Fax Number:
585-454-7328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2235 CLINTON AVE S
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:
14618-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-454-6720
Provider Business Practice Location Address Fax Number:
585-454-7328
Provider Enumeration Date:
11/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OLZINSKI-KUNZE
Authorized Official First Name:
ANN
Authorized Official Middle Name:
THERESE
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
585-454-6720

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  218923 , 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)





Copyright © 2007-2025 www.npivalidator.com