Basic Information
| Provider Information | |||||||||
| NPI: | 1235140252 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCHESTER UROLOGY GROUP, PLLC | ||||||||
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| OtherOrganizationName: | CENTER FOR UROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 CULVER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146091746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853365320 | ||||||||
| FaxNumber: | 5853369114 | ||||||||
| Practice Location | |||||||||
| Address1: | 2615 CULVER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146091746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853365320 | ||||||||
| FaxNumber: | 5853369114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | GLAZER | ||||||||
| AuthorizedOfficialFirstName: | ABRAHAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 5852274000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 208800000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.