Healthcare Provider Details

I. General information

NPI: 1750038972
Provider Name (Legal Business Name): UNIVERSITY ORTHOPAEDIC ASSOCIATES OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 S MAIN ST STE 3
CANANDAIGUA NY
14424-2208
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 665
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-602-1150
  • Fax: 585-433-9089
Mailing address:
  • Phone: 585-275-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JILL M HETTERICH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 585-756-4003