Healthcare Provider Details

I. General information

NPI: 1306941752
Provider Name (Legal Business Name): WESTSIDE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAKE AVE
ROCHESTER NY
14608-1017
US

IV. Provider business mailing address

480 GENESEE ST
ROCHESTER NY
14611-3634
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-6480
  • Fax: 585-295-6009
Mailing address:
  • Phone: 585-436-3040
  • Fax: 585-295-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number2701220R
License Number StateNY

VIII. Authorized Official

Name: LAURIE J. DONOHUE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 585-436-3040