Healthcare Provider Details

I. General information

NPI: 1730200478
Provider Name (Legal Business Name): PEDIATRICS AT THE BASIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/30/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 SUNRISE HL
PITTSFORD NY
14534-9778
US

IV. Provider business mailing address

32 SUNRISE HL
PITTSFORD NY
14534-9778
US

V. Phone/Fax

Practice location:
  • Phone: 585-233-5565
  • Fax: 585-586-4984
Mailing address:
  • Phone: 585-233-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number190299
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALICE A LOVEYS
Title or Position: PARTNER
Credential: M.D.
Phone: 585-233-5565