Healthcare Provider Details

I. General information

NPI: 1588249262
Provider Name (Legal Business Name): MARK L SARNOV MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 04/27/2024
Certification Date: 04/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1379 W RIDGE RD
ROCHESTER NY
14615-2412
US

IV. Provider business mailing address

1379 W RIDGE RD
ROCHESTER NY
14615-2412
US

V. Phone/Fax

Practice location:
  • Phone: 585-684-3556
  • Fax: 585-360-1701
Mailing address:
  • Phone: 585-684-3556
  • Fax: 585-360-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK LARRY SARNOV
Title or Position: OWNER
Credential: MD
Phone: 585-684-3556