Healthcare Provider Details

I. General information

NPI: 1053332189
Provider Name (Legal Business Name): VASCULAR SURGERY OF THE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
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
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVENUE BOX SURG
ROCHESTER NY
14642-8410
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-7743
  • Fax: 585-756-7750
Mailing address:
  • Phone: 585-275-1984
  • Fax: 585-756-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNY

VIII. Authorized Official

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