Healthcare Provider Details

I. General information

NPI: 1639719495
Provider Name (Legal Business Name): JUSTIN SARACENI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BANK ST FL 2
BATAVIA NY
14020-2250
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-7276
  • Fax:
Mailing address:
  • Phone: 585-343-4440
  • Fax: 585-343-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number345462
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: