Healthcare Provider Details

I. General information

NPI: 1497769764
Provider Name (Legal Business Name): MARK WINSBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 LONG POND RD UNITY PARK RIDGE CHEMICAL DEPENDENCY
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7350
  • Fax: 585-723-7353
Mailing address:
  • Phone: 585-922-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number187489
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number187489
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number187489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: