Healthcare Provider Details

I. General information

NPI: 1477548360
Provider Name (Legal Business Name): PAIN TREATMENT MEDICINE OF THE FINGER LAKES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HAGEN DR SUITE 230
ROCHESTER NY
14625-2658
US

IV. Provider business mailing address

PO BOX 2005
EAST SYRACUSE NY
13057-4505
US

V. Phone/Fax

Practice location:
  • Phone: 585-899-3450
  • Fax: 585-899-3454
Mailing address:
  • Phone: 315-449-0513
  • Fax: 315-445-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DONOVAN O HOLDER
Title or Position: OWNER
Credential: MD
Phone: 585-899-3450