Healthcare Provider Details

I. General information

NPI: 1700359726
Provider Name (Legal Business Name): PEDIATRIC URGENT CARE OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6687 PITTSFORD-PALMYRA RD SUITE 40
FAIRPORT NY
14450-1445
US

IV. Provider business mailing address

1800 MAPLE RD
WILLIAMSVILLE NY
14221-2749
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-5437
  • Fax:
Mailing address:
  • Phone: 716-636-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER GRISANTI
Title or Position: CFO
Credential:
Phone: 716-807-7435