Healthcare Provider Details

I. General information

NPI: 1467416768
Provider Name (Legal Business Name): MICHAEL BENJAMIN BOBROW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ERIE CANAL DR STE 200
ROCHESTER NY
14626-4609
US

IV. Provider business mailing address

120 ERIE CANAL DR STE 200
ROCHESTER NY
14626-4609
US

V. Phone/Fax

Practice location:
  • Phone: 585-719-9600
  • Fax: 585-719-9872
Mailing address:
  • Phone: 585-719-9600
  • Fax: 585-719-9872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number210151
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number210151
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number210151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: