1114382280 NPI number — INTERIM HEALTHCARE OF ROCHESTER

Table of content: (NPI 1114382280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114382280 NPI number — INTERIM HEALTHCARE OF ROCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE 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:
1114382280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 HALLOCK RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11790-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-689-8920
Provider Business Mailing Address Fax Number:
631-689-8955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 EAST AVE
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14604-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-434-2633
Provider Business Practice Location Address Fax Number:
585-434-2635
Provider Enumeration Date:
12/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HAMBURGER
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACT SPECIALIST
Authorized Official Telephone Number:
631-689-8920

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1060L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 8335001A , 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: 03157426 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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