Healthcare Provider Details

I. General information

NPI: 1346395126
Provider Name (Legal Business Name): ENGLISH ROAD PEDIATRICS AND ADOLESCENT MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ENGLISH RD
ROCHESTER NY
14616-1691
US

IV. Provider business mailing address

1800 ENGLISH RD
ROCHESTER NY
14616-1691
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2525
  • Fax: 585-225-2626
Mailing address:
  • Phone: 585-225-2525
  • Fax: 585-225-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN O'GARA
Title or Position: OWNER
Credential: MD
Phone: 585-225-2525