Healthcare Provider Details

I. General information

NPI: 1710941927
Provider Name (Legal Business Name): ROCHESTER GASTROENTEROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 LONG POND RD
ROCHESTER NY
14626-4117
US

IV. Provider business mailing address

790 LINDEN AVE
ROCHESTER NY
14625-2716
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-0111
  • Fax:
Mailing address:
  • Phone: 585-385-9030
  • Fax: 585-385-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number121861
License Number StateNY

VIII. Authorized Official

Name: MR. TARUN KOTHARI
Title or Position: OWNER
Credential: MD
Phone: 585-723-0111