Healthcare Provider Details

I. General information

NPI: 1245618594
Provider Name (Legal Business Name): AVRI BOHM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-1850
US

IV. Provider business mailing address

1444 E 22ND ST
BROOKLYN NY
11210-5111
US

V. Phone/Fax

Practice location:
  • Phone: 585-784-2985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number286634
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: