Healthcare Provider Details

I. General information

NPI: 1083318968
Provider Name (Legal Business Name): ALA A ALMANSOOB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 BUFFALO RD BLDG 800C
ROCHESTER NY
14624-1300
US

IV. Provider business mailing address

2300 BUFFALO RD BLDG 800C
ROCHESTER NY
14624-1300
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6370
  • Fax:
Mailing address:
  • Phone: 585-368-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number345650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: