Healthcare Provider Details

I. General information

NPI: 1710922364
Provider Name (Legal Business Name): DOROTA S GARDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ALEXANDER ST 2ND FL - WEST WING
ROCHESTER NY
14607
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-7770
  • Fax: 585-922-7246
Mailing address:
  • Phone: 585-922-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number039807
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number257860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: