Healthcare Provider Details

I. General information

NPI: 1871744664
Provider Name (Legal Business Name): BALTAZAR MELENDEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 PORTLAND AVENUE
ROCHESTER NY
14642
US

IV. Provider business mailing address

1089 SUMMITVILLE DRIVE
WEBSTER NY
14580
US

V. Phone/Fax

Practice location:
  • Phone: 585-544-4000
  • Fax:
Mailing address:
  • Phone: 585-217-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number022867-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: