Healthcare Provider Details

I. General information

NPI: 1538070339
Provider Name (Legal Business Name): NATALIA TLUSTOCHOWICZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE BLDG 3
ROCHESTER NY
14621-3095
US

IV. Provider business mailing address

35 SHADOWLAWN CT
ROCHESTER NY
14617-4106
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4000
  • Fax:
Mailing address:
  • Phone: 262-273-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number920140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: