Basic Information
| Provider Information | |||||||||
| NPI: | 1598776957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMESSER | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 SOUTH AVE | ||||||||
| Address2: | BOX 58 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146202733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853416770 | ||||||||
| FaxNumber: | 5853418305 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 SOUTH AVE | ||||||||
| Address2: | BOX 58 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146202733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853416770 | ||||||||
| FaxNumber: | 5853418305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 239209 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02885867 | 05 | NY | MEDICAID | P010239209 | 01 | NY | BLUE CHOICE | OTHER | 206040BU | 01 | NY | PREFERRED CARE | OTHER |