Healthcare Provider Details

I. General information

NPI: 1093865701
Provider Name (Legal Business Name): RIDGEWOOD MED-PEDS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 RIDGE RD W BUILDING C
ROCHESTER NY
14626-3249
US

IV. Provider business mailing address

3101 RIDGE RD W BUILDING C
ROCHESTER NY
14626-3249
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-1700
  • Fax: 585-225-1439
Mailing address:
  • Phone: 585-225-1700
  • Fax: 585-225-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTI COWELL
Title or Position: PARTNER/PHYSICIAN
Credential: MD
Phone: 585-255-1700