Basic Information
| Provider Information | |||||||||
| NPI: | 1497241236 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | ELLEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 SAINT ANDREWS BLVD | ||||||||
| Address2: | |||||||||
| City: | FAIRPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144504512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857480807 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1882 WINTON RD S | ||||||||
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| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146183950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856971557 | ||||||||
| FaxNumber: | 5856975692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2018 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other |
No ID Information.