Basic Information
| Provider Information | |||||||||
| NPI: | 1760737951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCHESTER GENERAL HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1208 DRIVING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145131057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153592640 | ||||||||
| FaxNumber: | 3153592645 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 DRIVING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145131057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153592640 | ||||||||
| FaxNumber: | 3153592645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2012 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | MIDOLO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5859221958 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 004088 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.