Healthcare Provider Details

I. General information

NPI: 1356309157
Provider Name (Legal Business Name): RUVIM FALKOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

IV. Provider business mailing address

100 KINGS HIGHWAY SOUTH PROVIDER ENROLLMENT
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-4941
  • Fax: 585-467-4626
Mailing address:
  • Phone: 585-922-1304
  • Fax: 585-922-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number203879
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: