Healthcare Provider Details

I. General information

NPI: 1497867782
Provider Name (Legal Business Name): GEORGE W ANSTADT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CARTER ST
ROCHESTER NY
14621-2604
US

IV. Provider business mailing address

800 CARTER ST
ROCHESTER NY
14621-2604
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 Number125901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: