Healthcare Provider Details

I. General information

NPI: 1689060360
Provider Name (Legal Business Name): KATHERINE CONGELOSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE DEPARTMENT OF OB/GYN, BOX 668
ROCHESTER NY
14642-0668
US

IV. Provider business mailing address

1820 S CLINTON AVE DEPARTMENT OF OB/GYN, BOX 668
ROCHESTER NY
14618
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-3733
  • Fax:
Mailing address:
  • Phone: 585-473-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number297407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: