MEDICARE: JOSHUA DANIEL PEZZULO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1144906678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA DANIEL PEZZULO MD

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVENUE BOX 665
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVENUE BOX 665
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-2047
Country	:	US
Telephone Number	:	585-602-2560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	05/11/2024

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