Healthcare Provider Details

I. General information

NPI: 1689023277
Provider Name (Legal Business Name): CARDIAC SURGERY OF THE UNIVERSITY OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-8410
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX SURG
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5384
  • Fax: 585-244-7171
Mailing address:
  • Phone: 585-275-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL M HETTERICH
Title or Position: SENIOR DIRECTOR OF FINANCE URMFG
Credential:
Phone: 585-756-4008