Healthcare Provider Details

I. General information

NPI: 1194714402
Provider Name (Legal Business Name): BORG & IDE IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 S CLINTON AVE
ROCHESTER NY
14618-2623
US

IV. Provider business mailing address

2263 S CLINTON AVE
ROCHESTER NY
14618-2623
US

V. Phone/Fax

Practice location:
  • Phone: 585-241-6400
  • Fax: 585-241-6505
Mailing address:
  • Phone: 585-241-6400
  • Fax: 585-241-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK S COHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 585-241-6400