1114302247 NPI number — CATHOLIC CHARITIES DIOCESE OF ROCHESTER

Table of content: DR. THOMAS FRANCIS GORMAN DDS (NPI 1992923494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114302247 NPI number — CATHOLIC CHARITIES DIOCESE OF ROCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES DIOCESE 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:
Provider Other Organization Name Type Code:
6
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:
1114302247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT MORRIS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14510-9727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-658-4466
Provider Business Mailing Address Fax Number:
585-658-2513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT MORRIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14510-9727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-658-4466
Provider Business Practice Location Address Fax Number:
585-658-2513
Provider Enumeration Date:
07/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BREWSTER
Authorized Official First Name:
TABITHA
Authorized Official Middle Name:
JON
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
585-658-4466

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04439209 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".