Healthcare Provider Details

I. General information

NPI: 1699129072
Provider Name (Legal Business Name): MICHAEL JOSEPH KANTOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

IV. Provider business mailing address

1455 E RIDGE RD
ROCHESTER NY
14621-2006
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2575
  • Fax: 585-922-5033
Mailing address:
  • Phone: 585-922-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number297292
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: