1518004027 NPI number — SIDNEY HILLMAN HEALTH CENTER OF ROCHESTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518004027 NPI number — SIDNEY HILLMAN HEALTH CENTER OF ROCHESTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIDNEY HILLMAN HEALTH CENTER 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:
1518004027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 EAST AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14607-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-473-2555
Provider Business Mailing Address Fax Number:
585-242-7580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 EAST AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14607-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-473-2555
Provider Business Practice Location Address Fax Number:
585-242-7580
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
STERLING
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
585-473-2555

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  011958 , 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: 011958 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3343667 . This is a "NABP#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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