Healthcare Provider Details

I. General information

NPI: 1588771471
Provider Name (Legal Business Name): BETH H. LERTZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WHITE SPRUCE BLVD
ROCHESTER NY
14623
US

IV. Provider business mailing address

300 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1606
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-6770
  • Fax: 585-424-6776
Mailing address:
  • Phone: 585-424-6770
  • Fax: 585-424-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number197921-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number197921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: