Healthcare Provider Details

I. General information

NPI: 1083027296
Provider Name (Legal Business Name): ROCHESTER MEDICAL WEIGHT LOSS, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 PORTLAND AVE SUITE 7
ROCHESTER NY
14621-2730
US

IV. Provider business mailing address

1299 PORTLAND AVE SUITE 7
ROCHESTER NY
14621-2730
US

V. Phone/Fax

Practice location:
  • Phone: 585-467-9790
  • Fax: 585-467-9798
Mailing address:
  • Phone: 585-467-9790
  • Fax: 585-467-9798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number190081
License Number StateNY

VIII. Authorized Official

Name: MRS. GULE-RANA MASOOD
Title or Position: OWNER
Credential: MD
Phone: 585-467-9790