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NPI Code Detail

MEDICARE: JOSIAH JAMES SURBATOVICH PHYSICIAN ASSISTANT

MEDICARE: JOSIAH JAMES SURBATOVICH PHYSICIAN ASSISTANT
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
1363AM0700XMedical Physician Assistant021172NY

General Provider Information

NPI Number : 1275045791
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSIAH JAMES SURBATOVICH PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 105 CANAL LANDING BLVD STE 1
Second Line :
City : ROCHESTER
State : NY
Zip : 14626-5107
Country : US
Telephone Number : 585-368-4050
Fax Number : 585-723-6705
Provider Business Practice Location Address
First Line : 170 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1227
Country : US
Telephone Number : 585-395-6052
Fax Number : 585-395-6007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2017
Last Update Date : 01/30/2018

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