Healthcare Provider Details

I. General information

NPI: 1952357493
Provider Name (Legal Business Name): UNIVERSITY UROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0002
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 278911
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5282
  • Fax: 585-275-2498
Mailing address:
  • Phone: 585-756-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL M HETTERICH
Title or Position: SR. DIRECTOR OF FINANCE-URMFG
Credential:
Phone: 585-756-4003