1710967534 NPI number — ROCHESTER CARDIOPULMONARY GROUP, P.C.

Table of content: (NPI 1710967534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710967534 NPI number — ROCHESTER CARDIOPULMONARY GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCHESTER CARDIOPULMONARY GROUP, P.C.
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:
1710967534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HAGEN DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14625-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-338-2700
Provider Business Mailing Address Fax Number:
585-338-2738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HAGEN DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14625-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-338-2700
Provider Business Practice Location Address Fax Number:
585-338-2738
Provider Enumeration Date:
01/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TROJAN
Authorized Official First Name:
IHOR
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
585-922-6100

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200770893 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101894 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6890 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180309590 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".




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