Basic Information
| Provider Information | |||||||||
| NPI: | 1194725788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADCOCK | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8000 | ||||||||
| Address2: | DEPT. 441 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445600 | ||||||||
| FaxNumber: | 7168445750 | ||||||||
| Practice Location | |||||||||
| Address1: | 995 SENATOR KEATING BLVD | ||||||||
| Address2: | BUILDING E STE 330 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852322980 | ||||||||
| FaxNumber: | 5852326522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 003405-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 003405 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 000921754002 | 01 | NY | HEALTH NOW | OTHER | 02625818 | 05 | NY | MEDICAID | PA0314 | 01 | NY | PREFERRED CARE | OTHER | 50606000004 | 01 | NY | FIDELIS | OTHER | 27164001 | 01 | NY | UNIVERA | OTHER | 9512854 | 01 | NY | IHA | OTHER | 9747 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER | P019003405 | 01 | NY | STRONG CARE | OTHER |