Healthcare Provider Details

I. General information

NPI: 1174595938
Provider Name (Legal Business Name): DR. JEANNE E GROVE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 WILLOW POND WAY
PENFIELD NY
14526-2638
US

IV. Provider business mailing address

5 MILE POST LN
PITTSFORD NY
14534-2213
US

V. Phone/Fax

Practice location:
  • Phone: 585-377-5420
  • Fax: 585-377-5635
Mailing address:
  • Phone: 585-377-5420
  • Fax: 585-377-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number156104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: