Healthcare Provider Details

I. General information

NPI: 1457526238
Provider Name (Legal Business Name): JOSEPH D KUEBLER M.D. , M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-3220
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 667
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-8138
  • Fax:
Mailing address:
  • Phone: 585-275-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number284711
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49823
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: