Healthcare Provider Details

I. General information

NPI: 1548296916
Provider Name (Legal Business Name): ANTHONY J SUOZZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S CLINTON AVE BLDG H SUITE 110
ROCHESTER NY
14618-2668
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 278980
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7139
  • Fax: 585-461-4426
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number169567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: