Basic Information
| Provider Information | |||||||||
| NPI: | 1497030381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCHESTER GENERAL HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | DEPARTMENT OF ORTHOPEDICS | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859223963 | ||||||||
| FaxNumber: | 5852665363 | ||||||||
| Practice Location | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | DEPARTMENT OF ORTHOPEDICS | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859223963 | ||||||||
| FaxNumber: | 5852665363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2011 | ||||||||
| LastUpdateDate: | 10/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | BURROUGHS | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5859223963 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 015178 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.