Basic Information
| Provider Information | |||||||||
| NPI: | 1225043706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RED CREEK ORTHOPAEDICS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 KENDALL ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144329701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154629482 | ||||||||
| FaxNumber: | 3154625438 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 RED CREEK DR | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146234272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853210110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 08/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | DAINO | ||||||||
| AuthorizedOfficialFirstName: | TERRANCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5853210110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.