Healthcare Provider Details

I. General information

NPI: 1326054883
Provider Name (Legal Business Name): JENNIFER NAYAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/06/2023
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE # 690
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

116 ALETA DR
ROCHESTER NY
14623-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5944
  • Fax: 585-273-1104
Mailing address:
  • Phone: 585-275-0747
  • Fax: 585-442-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number244192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: