MEDICARE: PED PHYSICAL DISABILITIES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
2	208800000X	Urology Physician
3	207X00000X	Orthopaedic Surgery Physician
4	207T00000X	Neurological Surgery Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1508809872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PED PHYSICAL DISABILITIES

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE
Second Line	:	BOX 635
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-7787
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 ELMWOOD AVE
Second Line	:	BOX 635
City	:	ROCHESTER
State	:	NY
Zip	:	14642-0001
Country	:	US
Telephone Number	:	585-275-7787
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JENNIFER KNEBEL
Credential	:
Telephone Number	:	585-275-7787

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

1346286895 — PEDIATRIC DEVELOPMENT CLINIC
Practice Location Address:

601 ELMWOOD AVE , BOX 635
ROCHESTER, NY
14642-0001

Practice Phone: 585-275-7787
Practice Fax:

1639107949 — DR. SUSAN L HYMAN MD
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601 ELMWOOD AVE , BOX 671
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1316975030 — DR. STEPHEN B SULKES MD
Practice Location Address:

601 ELMWOOD AVE , BOX 671
ROCHESTER, NY
14642-0001

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1306191119 — JENNIFER TOTRAN NGUYEN M.D.
Practice Location Address:

601 ELMWOOD AVE
ROCHESTER, NY
14642

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1578564985 — DR. LOWRY C SHROPSHIRE MD
Practice Location Address:

NNMC / PEDIATRICS , 8901 WISCONSIN AVE
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1144257742 — PHILLIP J HOLT MD
Practice Location Address:

2015 UPPERGATE DR NE
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Directions to “PED PHYSICAL DISABILITIES ” Practice Location

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