Healthcare Provider Details

I. General information

NPI: 1447281381
Provider Name (Legal Business Name): REPRODUCTIVE ENDOCRINOLOGY INFERTILITY GP OF UNIV OF ROCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RED CREEK DRIVE SUITE 220
ROCHESTER NY
14623-4276
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-487-3378
  • Fax: 585-334-8164
Mailing address:
  • Phone: 585-275-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL M HETTERICH
Title or Position: SENIOR DIRECTOR OF FINACE URMFG
Credential:
Phone: 585-756-4003