Healthcare Provider Details

I. General information

NPI: 1902852908
Provider Name (Legal Business Name): GREATER ROCHESTER NEUROLOGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

Provider Other Name: GREATER ROCHESTER NEUROLOGY

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 LAC DE VILLE BLVD
ROCHESTER NY
14618-5643
US

IV. Provider business mailing address

2101 LAC DE VILLE BLVD
ROCHESTER NY
14618-5643
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-3265
  • Fax: 585-232-5158
Mailing address:
  • Phone: 585-546-3265
  • Fax: 585-232-5158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology
License Number158572
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL GERARD DUNN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 585-546-7266