Healthcare Provider Details

I. General information

NPI: 1508100355
Provider Name (Legal Business Name): GREATER ROCHESTER BREAST SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2012
Last Update Date: 11/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 CLINTON AVE S
ROCHESTER NY
14618-2623
US

IV. Provider business mailing address

2235 CLINTON AVE S
ROCHESTER NY
14618-2623
US

V. Phone/Fax

Practice location:
  • Phone: 585-454-6720
  • Fax: 585-454-7328
Mailing address:
  • Phone: 585-454-6720
  • Fax: 585-454-7328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number218923
License Number StateNY

VIII. Authorized Official

Name: ANN THERESE OLZINSKI-KUNZE
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 585-454-6720