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NPI Code Detail

MEDICARE: ROCHESTER GENERAL LONG TERM CARE, INC

MEDICARE: ROCHESTER GENERAL LONG TERM CARE, INC
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
13336L0003XLong Term Care Pharmacy024859NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205927050
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCHESTER GENERAL LONG TERM CARE, INC
Provider Business Mailing Address
First Line : 1550 EMPIRE BLVD
Second Line :
City : WEBSTER
State : NY
Zip : 14580-2104
Country : US
Telephone Number : 585-922-2394
Fax Number : 585-922-2333
Provider Business Practice Location Address
First Line : 1550 EMPIRE BLVD
Second Line :
City : WEBSTER
State : NY
Zip : 14580-2104
Country : US
Telephone Number : 585-922-2394
Fax Number : 585-922-2333
Authorized Official
Title or Position : PRESIDENT
Name : MR. MARK CLEMENT
Credential :
Telephone Number : 585-922-2394
Provider Enumeration Date : 09/27/2006
Last Update Date : 09/21/2017

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