Healthcare Provider Details

I. General information

NPI: 1699761296
Provider Name (Legal Business Name): KAREN SUSAN PENIRD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HELENDALE RD SUITE 200
ROCHESTER NY
14609-3173
US

IV. Provider business mailing address

4998 SHORTSVILLE RD
SHORTSVILLE NY
14548-9739
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-7028
  • Fax: 585-473-0051
Mailing address:
  • Phone: 585-289-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number206615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: