Healthcare Provider Details

I. General information

NPI: 1518027747
Provider Name (Legal Business Name): SAJEENA MARIAM GEEVARGHESE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAJEENA MARIAM GEEVARGHESE MD

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PORTLAND AVE STE 245
ROCHESTER NY
14621-3022
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4496
  • Fax: 585-922-4442
Mailing address:
  • Phone: 585-922-4496
  • Fax: 585-922-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number48893
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number252718
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number252718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: