Healthcare Provider Details

I. General information

NPI: 1275533408
Provider Name (Legal Business Name): JEFFREY VUILLEQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

IV. Provider business mailing address

100 KINGS HWY S STE 300
ROCHESTER NY
14617-5501
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number207592-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: