Healthcare Provider Details

I. General information

NPI: 1497929806
Provider Name (Legal Business Name): KATHERINE BLUMOFF GREENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-1716
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 635
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2964
  • Fax: 585-242-9733
Mailing address:
  • Phone: 585-275-2964
  • Fax: 585-242-9733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.013387
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number262287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: