Healthcare Provider Details

I. General information

NPI: 1316962491
Provider Name (Legal Business Name): BRUCE FRANCIS CORSELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GOODMAN ST S
ROCHESTER NY
14607-3105
US

IV. Provider business mailing address

300 GOODMAN ST S
ROCHESTER NY
14607-3105
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-2755
  • Fax: 585-271-7358
Mailing address:
  • Phone: 585-271-2755
  • Fax: 585-271-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number145625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: