Healthcare Provider Details

I. General information

NPI: 1346234382
Provider Name (Legal Business Name): DIETER W AFFELN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3011
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4173
  • Fax: 585-922-5595
Mailing address:
  • Phone: 585-922-4173
  • Fax: 585-922-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number303227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: