Healthcare Provider Details

I. General information

NPI: 1225280910
Provider Name (Legal Business Name): ROCHESTER GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 DRIVING PARK AVE
NEWARK NY
14513-1057
US

IV. Provider business mailing address

1202 DRIVING PARK AVE
NEWARK NY
14513-1057
US

V. Phone/Fax

Practice location:
  • Phone: 315-359-2820
  • Fax:
Mailing address:
  • Phone: 315-359-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAULA TINCH
Title or Position: SVP- FINANCE
Credential:
Phone: 585-922-1223