Healthcare Provider Details

I. General information

NPI: 1851305627
Provider Name (Legal Business Name): VINEETH P JOHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CRITTENDEN BLVD
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

300 CRITTENDEN BLVD BOX PSYCH
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2247
  • Fax: 585-292-1747
Mailing address:
  • Phone: 585-275-2247
  • Fax: 585-292-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number43407
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43407
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: