Healthcare Provider Details

I. General information

NPI: 1184664948
Provider Name (Legal Business Name): STRONG MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CLINTON AVE S
ROCHESTER NY
14620-1448
US

IV. Provider business mailing address

135 CORPORATE WOODS STE 200C
ROCHESTER NY
14623-1459
US

V. Phone/Fax

Practice location:
  • Phone: 585-279-4800
  • Fax:
Mailing address:
  • Phone: 585-784-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL M HETTERICH
Title or Position: SENIOR DIRECTOR OF FINANCE URMFG
Credential:
Phone: 585-756-4008