Healthcare Provider Details

I. General information

NPI: 1124484423
Provider Name (Legal Business Name): SANJIV VIRDEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

6551 BEECHER DR
HORNELL NY
14843-9485
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2734
  • Fax:
Mailing address:
  • Phone: 585-420-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number282632
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number282632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: