Healthcare Provider Details

I. General information

NPI: 1457580532
Provider Name (Legal Business Name): BRIAN DEWAYNE DAY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 RIDGEWAY AVE STE A
ROCHESTER NY
14626-4127
US

IV. Provider business mailing address

1500 PORTLAND AVE
ROCHESTER NY
14621-3065
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2440
  • Fax: 585-663-3293
Mailing address:
  • Phone: 585-697-6000
  • Fax: 585-342-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA259723
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA259723
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: