1518416031 NPI number — CANANDAIGUA TRINITY OB/GYN, PLLC

Table of content: (NPI 1518416031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518416031 NPI number — CANANDAIGUA TRINITY OB/GYN, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANANDAIGUA TRINITY OB/GYN, 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:
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:
1518416031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 PARRISH ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANANDAIGUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14424-1784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-337-4335
Provider Business Mailing Address Fax Number:
585-337-4336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 PARRISH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANANDAIGUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14424-1784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-337-4335
Provider Business Practice Location Address Fax Number:
585-337-4336
Provider Enumeration Date:
09/26/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHEHATA
Authorized Official First Name:
HANI
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
607-731-8263

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  233381 , 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: 02579064 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".