Healthcare Provider Details

I. General information

NPI: 1326171471
Provider Name (Legal Business Name): CHRISTINE MARIE TIRK HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CANAL LANDING BLVD SUITE 3
ROCHESTER NY
14626
US

IV. Provider business mailing address

103 CANAL LANDING BLVD SUITE 3
ROCHESTER NY
14626
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-3440
  • Fax:
Mailing address:
  • Phone: 585-723-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000016079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: