Healthcare Provider Details

I. General information

NPI: 1992749733
Provider Name (Legal Business Name): PARKWAY PEDIATRICS & ADOLESCENT MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 ISLAND COTTAGE RD
ROCHESTER NY
14612-2349
US

IV. Provider business mailing address

353 ISLAND COTTAGE RD
ROCHESTER NY
14612-2349
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2610
  • Fax: 585-581-1396
Mailing address:
  • Phone: 585-225-2610
  • Fax: 585-581-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GRETCHEN SMITH BURKE
Title or Position: OWNER, PHYSICIAN
Credential: M.D.
Phone: 585-225-2610