1316904899 NPI number — SUZANNE BRENDZE M.D.

Table of content: SUZANNE BRENDZE M.D. (NPI 1316904899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316904899 NPI number — SUZANNE BRENDZE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENDZE
Provider First Name:
SUZANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1316904899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 EAST AVE
Provider Second Line Business Mailing Address:
HUTHER HEALTH CLINIC, FLOOR 3
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14604-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-325-5100
Provider Business Mailing Address Fax Number:
585-232-1275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
360 EAST AVE
Provider Second Line Business Practice Location Address:
HUTHER HEALTH CLINIC, FLOOR 3
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14604-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-325-5100
Provider Business Practice Location Address Fax Number:
585-232-1275
Provider Enumeration Date:
04/27/2006

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: 207Q00000X , with the licence number:  220446 , 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: P010220446 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CFP2204469W . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000498493001 . This is a "HEALTHNOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7217332 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02156132 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: MDF926 . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010220446 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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