Basic Information
| Provider Information | |||||||||
| NPI: | 1699851329 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCHESTER GENERAL HOSPITAL REHAB ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | BOX 242 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859223662 | ||||||||
| FaxNumber: | 5859225914 | ||||||||
| Practice Location | |||||||||
| Address1: | 1425 PORTLAND AVE | ||||||||
| Address2: | BOX 242 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859223662 | ||||||||
| FaxNumber: | 5859225914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AGGARWAL | ||||||||
| AuthorizedOfficialFirstName: | UMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR/ACUTE REHAB UNTI | ||||||||
| AuthorizedOfficialTelephone: | 5859225730 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 01451454 | 05 | NY | MEDICAID |