1487911863 NPI number — WEST RIDGE OBSTETRICS & GYNECOLOGY, LLP

Table of content: (NPI 1487911863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487911863 NPI number — WEST RIDGE OBSTETRICS & GYNECOLOGY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST RIDGE OBSTETRICS & GYNECOLOGY, LLP
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:
1487911863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 W RIDGE RD
Provider Second Line Business Mailing Address:
BLDG D
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14626-3249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-225-1580
Provider Business Mailing Address Fax Number:
585-225-2040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 W RIDGE RD
Provider Second Line Business Practice Location Address:
BLDG D
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14626-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-225-1580
Provider Business Practice Location Address Fax Number:
585-225-2040
Provider Enumeration Date:
04/23/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LESTORTI
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
585-720-8900

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  33D2030621 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 33D0884731 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 33D0700602 , 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: 207V00000X . This is a "TAXONOMY CODE MD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1992897409 . This is a "TYPE 1 NPI #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 363LX0001X . This is a "TAXONOMY CODE NP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".