Healthcare Provider Details

I. General information

NPI: 1326097825
Provider Name (Legal Business Name): COMMUNITY HOSPITAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E HENRIETTA RD
ROCHESTER NY
14620-4629
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX MED
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-6351
  • Fax: 585-760-6376
Mailing address:
  • Phone: 585-275-6275
  • Fax: 585-276-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL M HETTERICH
Title or Position: SENIOR DIRECTOR OF FINANCE
Credential:
Phone: 585-756-4008