Healthcare Provider Details

I. General information

NPI: 1790854974
Provider Name (Legal Business Name): RIDGEVIEW INTERNAL MEDICINE GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 RIDGE RD E
ROCHESTER NY
14622-2448
US

IV. Provider business mailing address

1850 RIDGE RD E
ROCHESTER NY
14622-2448
US

V. Phone/Fax

Practice location:
  • Phone: 585-342-3870
  • Fax: 585-342-7938
Mailing address:
  • Phone: 585-342-3870
  • Fax: 585-342-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GINA M SMALLWOOD
Title or Position: OFFICE MANAGER
Credential:
Phone: 585-342-3870