Healthcare Provider Details

I. General information

NPI: 1396937892
Provider Name (Legal Business Name): SURGICAL ONCOLOGY OF THE UNIVERSITY OF ROCHESTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-3332
  • Fax: 585-273-1251
Mailing address:
  • Phone: 585-273-3332
  • Fax: 585-273-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. MARTIN J HAIBACH
Title or Position: DIR. OF FINANCE AND ADMINISTRATION
Credential:
Phone: 585-273-4607